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! ! <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: ✓�recast Concrete Other Manufacture rw�� <br /> Tank Capacities: 1)�gal. 2) '"olJ gal 3) ��� gal <br /> B. Pump Station (if required) , <br /> Pump make & model (z,(�f� C�/�03%/ (attach pump curve & <br /> literature); system design requires Z-� gpm at ((' feet of head. <br /> High water alarm make& model /��-(g��•-� . Outside <br /> electrical work to be completed by installer �electrician other. <br /> C. Treatment System: <br /> -� Trenches:f 2�`� s.f. Mound <br /> Depth of rock below pipe �— " Rock bed dimensions ' x ' <br /> ;/Drop Boxes Sand bed dimensions ' x ' <br /> Distribution Box Pressure Dist. Pipe 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 /> a�rees to do all work in strict accordance�vith ordinances of the City and the regulations of the State <br /> of Nlinnesota,and certifies that all statements made on this application are complete,true and correct. <br /> SignatureofApplicant Date: I � � Z t� �— � � <br /> NIPCA License No. �P � � ' <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Ap rov Denial <br /> � _ � <br /> Reviewer: Date: � Z( � <br /> Reason for Denial: <br />