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r <br /> �♦ � <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate � <br /> boxes. <br /> 1. I have received a copy of the system design including the City of Orono Septic <br /> System Approval Cover Sheet. <br /> 2. I will be installing the following: � <br /> A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) gal. 2) gal 3) gal <br /> B. Pump Station(if required) <br /> Pump make& model (attach pump curve& <br /> literature); system design requires gpm at feet of head. <br /> High water alarm make& model . Outside <br /> electrical work to be completed by installer electrician other <br /> C. Treatment . � � <br /> Trenches: s.f. Maund <br /> Depzh of rock below pi�e " Rock bed dimensions ' x ' <br /> _Drop Boxes Sand bed dimensions ' x ' <br /> Distribution Box Pressure Dist. Fipe Diam. " <br /> Manifold 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 permit, <br /> agrees to do all work in strict accordance with ordinances of the City and the regulations of the State <br /> of Minnesota,and certifies that a 1 statements made on thi application are complete,true and correct. <br /> Signature ofApplicant / Date: � �7 <br /> NIPCA License No. � ��� <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval Denial <br /> Reviewer: Date• <br /> Reason for Denial: * <br />