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I�'OTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropria,te <br /> b oxes. <br /> � 1. I have received a copy of the system desi�n includinj the City of Orono Septi� - <br /> -- � <br /> System Approval Cover Sheet. <br /> � (� <br /> � ` ' 2. I�vill be installin�the followin�: <br /> A. Tanks: ✓Precast Concrete Other Manufacturer ��rw�'.✓ <br /> Tank Capacities: 1) /,3G�� gal. 2)��gal 3) gal <br /> B. Pump Station(if required) <br /> � Pump make& model (attach pump curve& <br /> /� r�w�� literature); system design requires gpm at feet of head. <br /> �G' <br /> Hijh water alarm make&model . Outside <br /> electrical work to be completed by installer electrician other. <br /> C. Treatme System: <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe " Rock bed dimensions ' x ' <br /> L�Drop Boxes Sand bed d'unensions ' x ' <br /> Distribution Box Pre�sure Dist. Pipe Diam. " <br /> ( �1" L��;,,c.��s� Nlanifold Pipe Diam. " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> � trucked in <br /> The undersijned hereby applies to the Ciry of Orono for is�uance of a septic system installation permit, <br /> a�rees to do all �vork in strict accordance with ordinances of the City and the re�ulations of the State <br /> of Nlinnesota,and certifies that all statements made on this application are complete,true and correct. <br /> Si�natureofApplicant Date: //� %— O i <br /> MPCA License No. (� �� <br /> -------------------------------------------------------------------------------------------------------------------_emo <br /> Staft'Revie�ti•: Approval / \ Denial <br /> Re��ie�ver: �� -'�w��,�.^ Date: � �— �� �� � <br /> Reason for Denial: <br />