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a . <br /> I�'OTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> b oxes. <br /> _ `� 1. I have received a copy of the system desi�n includinj the City of Orono Septic <br /> System Approval Cover Sheet. <br /> �_ 2. I�vill be installin�the following: Yw� <br /> � <br /> A. Tanks: �recast Concrete Other Manufacturer�cli sf <br /> Tank Capacities: 1) c'�� gal. 2) I 3dc� 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 in�taller electrician other. <br /> C. Treatment System: <br /> ✓ Trenches: �Zs s.f.,, Mound <br /> Depth of rock below pipe,q•���lcss" Rock bed dimensions ' x ' <br /> � Drop Boxes Sand bed dimensions ' x ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> 1�Ianifold Pipe Diam. " <br /> D. Final Cover/Topsoil to be: ti bonowed from site <br /> (show location on site plan) <br /> trucked in <br /> The undersijned hereby applies to the City of Orono for issuance ofa septic system installation permit, <br /> a�rees to do all �vork in strict accordance with ordinance� of the City and the rejulations of the State <br /> of l�linnesota,and certifies that all statement made on this application are complete,true and correct. <br /> SignatureofApplicant 5 Date: � `� j �{`'� ( <br /> MPCA License No. � � � <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> Staff Revie�ti•: Approval � Denial <br /> Reviewer: �� Date• b—�y ` b � <br /> Reason for Denial: <br />