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r <br />SQ?IC SYS?= Pl ? APPLICATM - PAGE 2 <br />Pemit Type i Fees (check one) <br />New Construction, Fr41'System $75.00. . . . . . . . . . . . . . . . . . <br />Replace Existinj hystem (1 or more new tanks i 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 WT MAIL PAMW WITH THIS, APPLICATION <br />NO'+'s: Applicant must initial all spaces. Fill in all appropriate blanks, <br />check all appropriate boxes. <br />initial <br />PtO 1. I have received a copy of the system design including the <br />:.'ity of Orono Septic System Approval Cover Sheet. <br />2. I will be installing the following: <br />A. Tenks: Precast Concrete Other Manufacturer! _ <br />Tank Capacities: 1) is gal . 2 ) _ gal. 3 ) /SOT, gal. <br />B. Pump Station (if required) <br />Pump make model 4 .a rw.f i[. 1P) D ( attach pump curve <br />literatuse)s system design requires �� 5Fm at Y%L, feet <br />of head. High water alarm make i mode To--t SWC _. <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 />' •enches: s . f . Mound <br />Deg of rock below pipe Rock bed dimensions L'x_L2' <br />Drop Boxes Sand bed dimensions 'x i2.' <br />Distribution Box Pressure Dist. Pipe D ll .1V c <br />Manifold Pipe Diam. L <br />D. Final Cover/Topsoil to be:X � borrowed from site <br />q% (show location site pla ) <br />trucked in <br />The undersigned hereby applies to the City of Orono for issuance of a <br />septic system installation permit, agrees t to all work in strict <br />accordance with the ordinances of the City and t: •qulations of the State <br />of Minnesota, and certifies that all statements it on this application <br />are complete, true and correct. <br />Signature of Applicant: G' �- <br />NICA Certification No.: 1 `> > .? <br />Date: <br />ice <br />