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SEPTIC SYSTEM PERMIT APPLICATOR - PAGE 2 <br />Permit Type i Fees (check one) <br />New Constructicl, 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 />ROTE: Applicant must initial al. spaces. Fill in all appropriate blanks, <br />check all appropriate boxes. <br />Inktial <br />1. I ha.,e received a copy of the system design including the <br />City of Orono Septic System Approval Cover Sheet. <br />2. I will be installing the following: Z� <br />A. Tanks: f/ r recast Concrete vOther Manfifacturer <br />Tank Capacities: 1) /off 5D gal. 2) DD gal. 3) 1� g 1. <br />B. Pump Station (if required) <br />Pump make & model 4j!w (attach p ump urve & <br />literature); system des g requires at6 0 feet <br />of head. High water alarm make & model <br />Outside electrical work to be completed by installer <br />,&lectrician _other Inside electrical work <br />must be completed by electrician. <br />C. Treatment System: <br />Trenches: s . f . <br />Depth of rock below pipe " <br />Drop Boxes <br />Distribution Box <br />x Mound ��. <br />R ck bed dimensions 'x ' <br />Sand bed dimension s�'x�' <br />Pressure Dist. ripe D am'�" <br />Manifold Pipe Diam %&_ <br />D. Final Cover/Topsoil to be: borrowed from site <br />(show location on site plan) <br />trucked in <br />*#*f::f:�:�:*::::**mot:s#�*eft***:fs#:;tf+r:�� :#f�*f:*�#f:*::*:*,r:::tf:f::*• <br />The undersigned hereby applies to the City of Orono for issuance of a <br />septic system installaticn 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 certifie hat all statements made on this application <br />are complete, true and co ec . <br />Signature of Applicant: Date: J onr-) <br />MPCA Certification No.: P,'n2 ✓ <br />