Laserfiche WebLink
., • <br />SEPTIC SYSTEM PERMIT APPLICATOR - PAGE 2 <br />Permit Type s Fees (check one) <br />New 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 ROT MAIL PAM= MITE THIS APPLICATIOR <br />ROTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br />check all appropriate boxes. <br />Initial <br />�i. <br />I have received a copy of the system design including the <br />City of Orono Septic System Approval Cover Sheet. <br />• <br />2. I will bestalling the following: �-- <br />A. Tanks: �pprecast Concrete Other Manufacturer ' 4*_e_4!-+v <br />Tank Capacities: 1) a�qal. 2) /�*�J gal. 3) gal. <br />B. Pump Station (if required) <br />Pump make i model _, - L (attach pump curve : <br />literature); syst sign requires mat //� feet <br />of head. High water alarm make i mo a L•-« <br />out electrical work to be completed by —installer <br />Le'electrician other Inside electrical work <br />must be completes by a ectr c an. <br />C. Treatment System: <br />Trenches: s.f. �und <br />Depth of rock -bed pipe " Rock bed dimensions'' <br />Drop Boxes Sand bed dimen:iam. <br />ions x' <br />Distribution Box Pressure Dist.Pipe am." <br />Manifold Pipe I,�Z <br />D. Final Cover/Topsoil to be: 1L -borrowed from site <br />/ (show location on site plan) <br />l trucked in <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 />,1 , <br />Signature of Applicant: �' C''t ` Date: <br />MPCA Certification No.: ij <br />