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�. <br /> _ � <br /> ;EPTIC SYSTEM PERMIT APPI.ICATON - PAGE 2 <br /> Permit Type � Fees (check one) <br /> � New Construction, Full System $100 . 00 . . . . . . . . . . : : : . <br /> Repair or Replace Existing System $50 . 00 . . . . . . . . . <br /> 0 . 50 State surcharge added to above permi fees <br /> SEE FEE SCHEDULE FOR NON-RESI ENTIAL PERMIT FEES <br /> DO NOT MAIL PAYMENT WITH IS APPLICATION <br /> a��***�t*t*t��f*�****#***�***�tf*�r��r�t#***�*� �t*#***�***ytf*��t*�r**�****�t�t��r�*** <br /> dOTE: Applicant must initial all spaces. Fill in aZl appropriate blanks, <br /> check all appropriate boxes . � <br /> Initial <br /> 1. I have received a copy of he system design including the <br /> City of Orono Septic System Approval Cover Sheet. <br /> 2. I will be installing the fo lowing: <br /> A. Tanks: �Precast Concrete Other Manufacturer <br /> Tank Capacities : 1) ZT al. 2 ) l Z� gal. 3 ) f ZT�". gaI. <br /> B, Pump Station (if required) <br /> Ptunp make & model (attach pump curve & <br /> Ziterature) ; syste_m design equires �gpm at �= f eet <br /> of head. Hi gh water a 1 arm make & mo e 1 <br /> Outside el.ectrical work to be completed by _installer <br /> electrician other Inside electrical work <br /> must be completed by electr cian. <br /> C. Treatment System: <br /> Trenches: s.f. Mound <br /> Depth of rock bel.ow pipe ` Rock bed dimensions j�'x(�y�' <br /> Drop Boxes - Sand bed dimensions r��'x�'- <br /> Distribution Box Pressure Dist. Pipe iam. 2� " <br /> Manifold Pipe Diam. _�_" <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show Iocation on site plan) <br /> trucked in <br /> f*�**�*�*�*�**t****t***t*****�****�f****t�* ***�ttt**�t*#ttf*****�***�t��** <br /> mhe undersigned hereby appl.ies to the C ty of Orono f or issuance of a <br /> septic system installation permit, agr es to do all. work in strict <br /> accordance with the ordinances of the City nd the regulati.l,ons of the State <br /> �i Minnesota, and certifies that all stat ments made on this application <br /> are comp lete, true and correct. � � <br /> Signature of Applican Date: <br /> _dPCA Certification No. : � � <br />