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$BPTIC SYSTM Pffi2MIT APPLICATM - PAGE 2 <br />Permit Type i p <br />New Construction, Full System $75.00 <br />Replace Existing System U or more .. <br />?a--tial Replacement (replac= just tau:, <br />$0.50 State surcharge added to above p <br />SEE FEE SCHEDULE FOR NCN-:. <br />Y one) <br />-ainfield) $o0.00. . <br />rainfield) $30.00. . <br />. PERMIT Fr-rS <br />DO HOT MAIL PAM43NT WITH TST S APPLICATION <br />sssssssssssstsssssssssssssfsssss*sssss:*:��:�.r:sssssss:��ssss:sss,rssss•-ssss <br />70T8: Applicant must initial all spaces. F....1 in all appropriate blanks, <br />check all appropriate boxes. <br />1. I have received a copy of the sy.atem design including the <br />.City of Orono Septic System Approval Cover Sheet. <br />2. I will be installing the following: [[ <br />A. Tanks: Precast Concrete V' Other Manufacturer <br />Tank Capacities: 1) gal. 2) c�ogal. 3) _gal. <br />B. Pumn Station (i= re red) <br />Pump make & model (attach puma curve & <br />literature) ; syste_^t design re-iires cpm at feet <br />of head. High water alarm make & model <br />Outside electrical work to be completed by _installer <br />— electrician other Inside electrical wok <br />must bM completed by electrician. - 'r : ✓ t�fv-A ^ ^� <br />C. Treatment System: <br />Trenches: s.f. <br />Depth of rock below pipe " <br />Drop Boxes <br />Distribution Box <br />Mound <br />Rack bed dimensions /' ' x SV' <br />Sand bed dimensions M'x' <br />Pressure Dist. Pipe Diam._ZA-" <br />Manifold Pipe Diam. 0 <br />D. Final Cover/Topsoil to be: borrowed from site <br />(show location on site plan. <br />trucked in <br />•s**sus:�:suss:susssus,reuses*�s:sis�fs:s:s::f:��*sasfsee�sei:�*a::f:s**se <br />-.a undersigned hereby applies to the City of Orono for issuance of a <br />t-tic system installation permit, agrees to do all work in strict <br />:cordance with the or3inances of the City and the regulations of the State <br />Minnesota, and certifies that all statements made on this application <br />complete,. true and Corr-.t. <br />mature of Applicant: Date:_��?rc t' <br />CA Certification No.: % �� <br />