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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes,, <br /> �'-� � 1. I have received a co y of the s stem desi n includin the Ci of Orono Se tic <br /> P Y g g tY P <br /> System Approval Cover Sheet. <br /> ,� <br /> _�� 2. I will be installin f <br /> g�l�e ollowing: _ <br /> A. Tanks: �/�PrecastConcrete Other �fanufacturert��``U'"' <br /> Tank Capacities: 1) /Uo�%' gal. 2) l�G gaI 3) �"� gal <br /> B. Pump Station (if required) <br /> Pump make& model_ �;:�-� �1��' (attach pump curve& <br /> literature); system design requires ! gpm at 5�� feet of head. <br /> High water alarm make& model C�,�-z(�Y�� . Outside <br /> electrical work to be completed by installer electrician -�' other. <br /> C. Treatment System: <br /> Trenches: s.f. `�" Mou�d <br /> Depth of rock below pipe " Rock bed dime�sions%U ' x �{l' <br /> Drop Boxes Sand bed dime�;ions �_' x�Z' <br /> Distribution Box Pressure Dist. Pipe Diam. � %z " <br /> Manifold Pipe Diam. �- " <br /> D. Final Cover/Topsoil to be: borrowed fron site <br /> (show locatio�on site plan) <br /> � trucked in <br /> The undersigned hereby applies to the City of Orono for issuance of a septic sys:em installation permit, <br /> agrees to do all work in strict accordance with ordinances of the City and the rejulations of the State <br /> of Minnesota,and certifies that all statements made on this application are complete,true and correct. <br /> _.______ <br /> ___.__ __.---__-----_. <br /> SignatureofApplicant Date: %� " z- 7 � ��� <br /> MPCA License No. � �C/ <br /> ----------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval �' Denial <br /> Reviewer: ��t�(.(# ��y�r--z� Date• �� --�--� —(->� � <br /> Reason for Denial: <br />