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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br />Permit Type a Fees (check one) <br />New Construction, Full System $100.00 . . . . . . . . . . . . . . <br />Repair or Replace Existing System $50.00 . . . . . . . . . . . . . <br />$0.50 State surcharge added to above permit fees <br />SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br />DO NOT !TAIL PAYMENT WITH THIS APPLICATION <br />s�l�:::*::f�*��t�*•��**ff�:�+t���*���f��:�*:t�::#:t:�t�:�f�*f���fft�ett*�*t��f <br />NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br />check all appropriate boxes. <br />Initial <br />�1. I have received a copy of the system design including the <br />City of Orono Septic System Approval Cover Sheet. <br />2. <br />A. <br />B. <br />1 LlJrde inn f,* /-C <br />I will be installing the following: <br />Tanks: Precast Concrete Other Manufacturer <br />Tank Capacities: 1) 12-5-0 gal. 2 ) JO(,0 gal. 3 ) JSGO gal. <br />Pump Station (if required) i� <br />Pump make & model O.ClJd LOEOS1k ,P ' (attach pum . curve & <br />literature); system design requires Z qpm at .27 _ feet <br />of head. High water alarm make & model �.e�zlARw. - ")LV <br />Outside electrical work to be completed by _installer <br />.X electrician _other In -de electrical work <br />must be completed by electrician. <br />C. Treatment System: <br />�, <br />Trenches: s.f. <br />04A Mound <br />t O ' <br />Depth of rock below pipe <br />Rock bed <br />dimensions <br />x'7S' <br />Drop Boxes <br />Sand bed <br />dimensions <br />33'" x AoV <br />Distribution Box <br />Pressure <br />Dist. Pipe <br />Diam. <br />Manifold <br />Pipe Diam. <br />9 " <br />D. Final Cover/Topsoil to be: 3t4 borrowed from site <br />sc,1 fib. bdo-tw%&- t - tti.Q,�,% t ( show location on site plan) <br />C...ck Sa,v.Q ,� I bt trucked in <br />The undersigned hereby applies to the City of Orono for issuance of a <br />septic system installation permit, agrees to do all work in strict <br />accordance with the ordinances of the City and the regulations of the State <br />of Minnesota, and certifies that all statements made on this application <br />are complete, true and correct. <br />Signature of Applicant: 1Date: 2 <br />MPCU Certification No.: �� �T <br />