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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit Type � Fees (check one) <br /> New Construction, Full System $100. 00 . . . . . . . . . . . . . <br /> �x Repair or Replace Existing System $50. 00 . . . . . . . . . . . . . <br /> $0. 50 State surcharge added to above permit fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYMENT WITH THIS APPLICATION <br /> �**�***�t****���**t*�****:�**�***��*�*���*��******�t***�**:*******�***�***� <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br /> check all appropriate boxes. <br /> Initial <br /> no l. I have received a copy of the system design including the <br /> City of Orono Septic System Approval Cover Sheet. <br /> 2 . I will be installing the following: <br /> A. Tanks: �Precast Concrete X Other Manufacturer <br /> Tank Capacities: 1) 1000 gal. 2 � 1000 qal. 3 ) 1000 qal. <br /> B. Pump Station (if required) <br /> Pump make & model Blue Angel (attach pump curve & <br /> literature) ; system design requires �_gpm at �� feet <br /> of head. High water alarm make & model anrhn <br /> Outside electrical work to be completed by _installer <br /> x electrician other Inside electrical work <br /> must be completed by electrician. <br /> C. Treatment System: <br /> Trenches: s.f. X Mound <br /> Depth of rock below pipe " Rock bed dimensions 10 'x41 ' <br /> Drop Boxes Sand bed dimensions �'x�$�' <br /> Distribution Box Pressure Dist. Pipe Diam. T2 " <br /> Manifold Pipe Diam. 2 " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> x trucked in <br /> ********:***********��*�r�****#**�****�*****:****��****�**�*****�*****���*** <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 /> � �� <br /> Signature of Applicant� Date: ' ,� ��5� <br /> � <br /> MPCA Certification No. ��j^�_ <br />