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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> i � 1. I have received a copy of the system desijn including the City of Orono <br /> Septic System Approval Cover Sheet. <br /> 2. I will be installing the followin�: <br /> A. Tanks: Precast Concrete Other Manufacturer <br /> �� � �,_ z,_ Tank Capacities: 1) ga1. 2) �al. 3) �al. <br /> � � <br /> � � �_� �� , B. Pump Station (if required) <br /> (� � ��� -- � . < < Pump make & model (attach pump curve & <br /> literature); system desi�n requires �pm at feet of head. <br /> High water alarm make & model . Outside <br /> C��,n�e�� /�'��'/�� �(��lectrical work to be completed by installer electrician <br /> � ocher Inside electrical work must be completed by <br /> Sy�� � ��}� electrician. <br /> , <br /> �����1 Ur% ����J C. Treatment System: <br /> �� Ggy� � Trenches: s.f. Mound <br /> J <br /> � � , �r, r�� Depth of rock below pipe " Rock bed dimensions 'x ' <br /> ��'�`�1���'�J `'G'A ` Drop Boxes Sand bed dimensions 'x ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Maniford Pipe Diam. " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> trucked in <br /> The undersigned hereby applies to the City of Orono for issuance of a septic system installation <br /> permit, a�rees to do all work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minnesota, and certifies that all statements made on this application <br /> are complete, true and correct. <br /> �; �� � �� <br /> SignatureofApplicant��''�'� � '�� Date: r'�'' `- <br /> - , <br /> _– ; J � �, <br /> MPCA Certification N�: <br /> /' —����� , <br /> Staff Review: Approval � Denial <br /> , <br /> Reviewer: � '� �o �� <br /> Date: �-; `' <br /> _ -T <br /> Reason for Denial: <br />