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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> l. 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 installin?the followin�: <br /> A. Tanks: �_Precast Concrete Other Manufacturer � ��,t '���.�.,. ���� <br /> l�'�4i1-4.�k <br /> Tank Capacities: 1) aoo �al, 2) �o�o ,�a 3) �al <br /> B. Pump Station (if required) <br /> Pump make& model �w� ��� (attach pump curve& <br /> literature); system design requires 'Z b gpm at 2o feet of head. <br /> High water alarin make & model 2•+ s�ol� �•�c . Outside <br /> electrical work to be completed by installer K electrician � other. <br /> C. Treatment System: �^��+��, <br /> S� Trenches: s.f. Mound <br /> Depth of rock below pipe " Rock bed dimensions ' x ' <br /> �C' Drop Boxes Sand bed dimensions ' Y ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Manifold Pipe Diam. " <br /> 8_ri.. <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 with ordinances of the City and the rejulations of the State <br /> of Nlinnesota,and certifies that all statements made on this application are complete,true and correct. <br /> SignatureofApplicant Date: �-2� -U� <br /> NIPCA License No. � ?� <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Rev�e�v: Appa-ovafl V Deniai <br /> Revie�ver: ,��/�,l���� �>_�� D�te• �• o�/� � <br /> �easoa� for �e�ia�: <br />