Laserfiche WebLink
.EPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br />/ Permit Type & Fees (check one) <br />y1 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 !SAIL PAYMENT WITH THIS APPLICATION <br />30TE: 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 desigi including the <br />City of Orono Septic System Approval Cover Sheet. <br />2. I will be *"talling the following: <br />A. Tanks: ci, Precast Concrete Other Manufacturer <br />Tank Capacities: 1) 1250 gal. 2 ) 1000 gal. 3 ) j1s4 gal. <br />B. Pump Station (if required) <br />Pump make & model w1rc, (attach pump curve & <br />literature); system design requires a gpm at feet <br />of h ad. High water alarm make & mo el DL !� <br />Ou side 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: s.f. <br />Depth of rock below pipe " <br />Drop Boxes <br />Distribution Box <br />Mound <br />Rock bed dimensions/0 'x_Lf <br />Sand bed dimensions ='x_L <br />Pressure Dist. Pipe Diam." <br />Manifold Pipe Diam. 2 <br />Final Cover/Topsoil to be: _borrowed from site <br />(show location on site plan) <br />trucked in <br />:::*t:::*:*:�t�:*:f*:::�**#s�•f*:***:�:t**:�►:tt*::ts�fs::::t:::f:*::*t:*!mot <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��x�.,,c �„�. Date: /0 aI 2 z_ <br />_SPCA Certification No.: %(J o <br />