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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br />Permit Type & % ees (check one) <br />ew Construction, Full System $75.00. . •. . . . . . <br />Replace Existing System (1 or more new tanks &drainfield) $50.00. . . <br />Partial Replacement (replace just tanks or just drainfield) $30.00. . . <br />$0.50 State surcharge added to above permit fees <br />SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br />DO NOT MAIL PAYMENT WITH THIS APPLICATION <br />MOTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br />check all appropriate boxes. <br />Initial <br />ir<� 1. I have received a copy of the system design including the <br />City of Orono Septic System Approval Cover Sheet. <br />2J--'r- 2. I will b installing the following: <br />A. Tanks: Precast Concrete Other Manufacturer <br />Tank Capacities: 1) gal. 2) gal. 3) gal. <br />B. Pump Station (if required) <br />Pump make & model (attach pump curve & <br />literature); system design requires gpm at feet <br />of head. High water alarm make & model <br />Outside electrical work to tv completed by _installer <br />electrician other Inside electrical work <br />must be completed by electrician. <br />C. Treatment System: <br />Trenches: s. f . <br />De th of rock below pipe 1 2 " <br />Drop Boxes <br />Distribution Box <br />Mound <br />Rock bed dimensions 'x ' <br />Sand bed dimensions 'x_ ' <br />Pressure Dist. Pipe Haw, " <br />Manifold Pipe Diam. <br />D. Final Cover/Topsoil to be: )< borrowed from site <br />(show location on site plan) <br />trucked in <br />•fEst.r+r+rs*spa+�:*sw*���sss**:s:f*:s�ts�::*e:*�:*��s�:str*�*��*s*,►w*#:se�wsss <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: �i' /li�1+r- Date: <br />MPCA Certification No.: 7 7,1?' <br />