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Peraiit Type & Fees (check one) . <br />/rew Construction, Pull System $75.00. . . . . . . . . . . ... . . . . . . . <br />^ eplace Existing System (1 or more new tanks & drainfield) $50.00. • • <br />artial Replacement (replace just tanks or just drainfield) $30.00. . <br />• ■* ■ <br />12PnC S7STSM PERMIT APPLZCATOH - PAGE 2 <br />0.50 State surcharge added to above permit, fees ~ <br />SEE FEB SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br />DO HOT MAIL PAIMENT HZTH THIS APFLICATIOR <br />OTSs Applicant must initial all spaces. Fill in all appropriate blanks, <br />check all appropriate boxes. <br />litial <br />1. I have received a copy of the system design including the <br />. City of Orono Septic System Approval Cover Sheet. <br />2. I will be installing Uie following: <br />A. Tanks: Precast Concrete ___^Other Manufacturer <br />Tank Capacities: 1) gal. 2) gal. 3) ) "Z-s^ gal. <br />B.Pumc Station (if required) <br />Pump make & modelT^,?/ _ _ _ _ (attach pump curve & <br />literature); system design requires feet <br />of head. High water alarm make 5 modelx^^/^^ <br />Outside electrical work to be completed by ^installer <br />electrician _other_ _ _ __. Inside electrical work <br />must be completed by electrician. <br />C.Treatment System: <br />Trenches: <br />Depth of rock below pipe <br />s.f. <br />Drop Boxes <br />Distribution Box <br />Mound <br />Rock bed dimensions jo *x^g * <br />Sand bed dimensions 4/iO *X/g</ * <br />Pressure Dist. Pipe Diam._^ <br />Manifold Pipe Diam. 2 _** <br />D. Final Cover/Topsoil to be: \<^ borrowed from site <br />(show location on >*ite plan) <br />trucked in <br />^ underslgn.d h.r.by «ppli*s to the City of Orono for issuance of a <br />tic system installation permit, agrees to do all work in strict <br />ordance with the ordinances of the City and the regulations of the State <br />Minnesota, and certifies that all statements made on this application <br />complete,, true and correct. <br />uatur^of Applicant: <br />A Certification Ho.:_2Zl2. <br />Date g <br />I