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I: <br />SBPTIC SYSTEM PERMIT APPLICATOR - PAGE 2 <br />Peznit Type ft Fees (check one) <br />New Constructionp Full System $75.00. . . . . . . . . . . . . . . . <br />Replace Existing System (1 or more new tanks ft dralnfleld) $50.00 <br />Partial Replacement (replace just tanks or just dralnfleld) $30.00. • . <br />• • e <br />$0.50 State surcharge added to above permit fees <br />SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br />DO MOT MAIL PAYMENT WITH THIS APPLICATION <br />NOTE: Appllr:. must initial all spaces. Fill in all appropriate blanks, <br />check al^ 4ppropriate boxes. <br />Initial <br />1.ecelved a copy of the system design including the <br />Orono Septic System Approval Cover Sheet. <br />2. <br />A. <br />I V <br />Tanksr <br />*)e installing the following: <br />^Precast Concrete Other Manufacturer <br />Tank Capacities ? 1) <br />^ \ I'S <br />/tcc^^gal. 2) gal. 3) /25to <br />B.Piamp Station (if required) <br />Pump make ft model 6c./ <br />gal. <br />K L____________________tattach pump curve ft <br />literature ); system design requllrea —^7 cnsm at feet <br />of head. High water alarm make ft model L^tyJAi^tn <br />Outside electrical work to be completed by install^ <br />A^lectriclan __other____________. Inside electrical wOi.A. <br />must be completed by electrician. <br />C.Treatment System: <br />Trenches:s.f. <br />Depth of rock below pipe <br />Drop Boxes <br />Distrl Ion Box <br />D. Final Cover/Topsoil to be: X <br />X Mound <br />Rock bed dimensions /o *x 6^* <br />Sand bed dimensions^/' * <br />Pressure Dlst. Pipe Dlam. /A. * <br />Manifold Pipe Diam. >2 ^ ^ <br />borrowed from site-^T^-^^v>». <br />(show location on slte^lafi)c/r^ <br />_ _ trucked in » / <br />****«*«***********e***<**y >*****•*•#*•**#••••**••*#*•#*****•*♦**••♦•♦*•♦**♦• / / <br />The undersigned hereby applies to the City of Orono for Issuance of a t? <br />septic systeti. Installation permit, agrees to do all work in strict <br />accordance with the ordlnani of ihe City and the regulations of the State <br />of Minnesota; and certifl'v^ ciiat oil statements made on this application <br />are complete,, true and correct. <br />Signature of Applicant:, <br />MPCA Certification No.: <br />6?. M <br />V9-/\ <br />Date; ^ <br />-f)V I