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8BPTXC SYSTEM PERMIT APPLICATOH - PAGE 2 <br />Perait Type ft Fees (check one) <br />Mew 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 />Jt <br />$0.50 State surcharge added to above permit fees <br />SEE FEE SCHEDULE FOR NOM-RESIDENTIAL PERMIT FEES <br />DO MOT MAIL PAYMENT MITE THIS APPLICATION <br />MOTES Applicant must initial all spaces, <br />check all appropriate boxes. <br />Fill in all appropriate blanks. <br />Initial <br />1.I have received a copy of the system design including the <br />City of Orono Septic System Approval Cover Sheet. <br />2. I will be installing the following: <br />A. Tanka: Precast Concrete ___^Other Manufacturer <br />Tank Capacities: 1)gal. 2).gal. 3)gal. <br />B.Pump Station (if required) , <br />Pump make & modelU* ijuiTF;?* >.7^ ill <br />literature); system design requires _ _ <br />of head. High water alarm make & model <br />_ (attach pump curve & ^ <br />HC\_gpm at feet <br />Outside electrical work to be completed by install^ <br />i/felectrician __pother____________. Inside electrical work <br />must be completed by electrician. <br />c.Treatment System: <br />Trenches:s. f.t <br />Depth of rock below pipe <br />_ _ Drop Boxes <br />Distribution Box <br />_ _ Mound ^ <br />" Rock bed dimensions fO *x ?7 * <br />Sand bed dimensions u r *x ir*r* <br />Pressure Dist. Pipe Diam. fV>-" <br />Manifold Pipe Diam. 7^ <br />D. Final Cover/Topsoil to be:borrowed from site <br />(show locat^n on site plan) <br />trucked in <br />>cat^] <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: A V <br />NPCA Certification No.: <br />Date:tn-t- TO <br />OK- issue