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SEPTIC SZSTZK PMtMIT APPLICATOR - PAGZ 2 <br />_ _ y ....fir ....•¢ ♦r•, <br />Permit Type : Fees (check one) <br />New Construction, Full System $75.00. . . . . . . . . . . . . . . . . . <br />Replace Existing System (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 KAIL PAIIMT WITH THIS APPLICATION <br />r�:••r:ess:at:•ss•�*wef!*swssee**se:ef:*,►:*:*:se*:::e*�fes:sss�e•*,ee*•as**s <br />XOTZz 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 design including the <br />cc .City of Orono Septic System Approval Cover Sheet. <br />L� 2. I will be installing the following: <br />A. Tanks: Precast Concrete Other Manufacturer <br />Tank Capacities: 1) tOQn gal. 2 ) /pa.? _gal. 3 ) 1C.�y gal. <br />B. Pump Station (if required) <br />Pump make i model p��,,,,/, ,.,s SE41i (attach pump curve <br />literature) ; system design requires gpm at I'll 2 feet <br />of head. High water alarm make t model ---�` <br />Outside electrical work to be completed by _)Snstal er <br />electrician other . Inside electrical work <br />must be completed by electrician. <br />C. Treatment System: <br />Trenches: s.f. Mound <br />Depth of rock below pipe Rock bed dimensions/a_'xc' <br />Drop Boxes Sand bed dimensions <br />Distribution Box Pressure Dist. Pipe <br />Manifold Pipe Di_ <br />D. Final Cover/Topsoil to be: borrowed from site <br />(show location on site plan) <br />trucked in <br />•sss••**se•ssi:esisefs:*aefe♦ss�***:se�e�s:s�sse*:s•*estsei•e**f*es�fe**•s <br />he undersigned hereby applies to the City of Orono for issuance of a <br />optic system installation permit, agrees to do all work in strict <br />:cordance with the ordinances of the City and the regulations of the State <br />Minnesota, and certifies that all statements made on this application <br />=e complete,. true and correct. <br />:gnature of Applicant: ��— Date: -31 - L, <br />'CA Certification No.: ?� Q' <br />