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.� <br /> NOTE: Applican ust 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 followin�: <br /> A. Tanks: �_Precast Concrete Other Manufacturer t�A�c..�.� �.c�c.�S t <br /> Tank Capacities: 1) i�v�j jal. 2) gal 3) gal <br /> 5�t:�-}-- <br /> B. Pump Station (if required) <br /> Pump mak & model (attach p p curve& <br /> literature); sy em design requires gpm at feet of head. <br /> High water alarm ake & model . Outside <br /> electrical work to be c leted by installer electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. l�lound <br /> Depth of rock below pipe " ock bed dimensions ' x ' <br /> Drop Boxes Sa bed dimensions ' x ' <br /> Distribution BoY Press Dist. Pipe Diam. " <br /> Manifol ipe Diam. " <br /> D. Final Cover/Top il to be: borrowed fro ite <br /> (show location on ite plan) <br /> trucked in <br /> The undersi�ned hereby applies to the Gity of Orono for issuance of a septic system installation permit, <br /> agrees to do all �vork in strict accordance with ordinances of the City and the re�ulations of the State <br /> of l�Iinnesota,and cenifies that all statements made on this application are complete,true and correct. <br /> Si�nature ofApplicant �, _ �,� Date: l t-- �-O S <br /> tiIPCA License No. Z�Z� <br /> ---�-------------------------------------------------------------------------------------------------------------------�-- <br /> 5��f'��er�e���: �p��'ova9 � �enfl�� <br /> , �' C� �� <br /> 4 � <br /> �pvi�s��g�; �� � /-r' ��� D�±e: � � <br /> �e�son �c�q� �e�aal: I�D�'�tepc��.e1- /�-� s� A l��� ��! �o(' lc�.� �,`f;�x �l� <br /> tJ:S� �C��,'�' �S A 1�:, ,�.!- �� •�-I�,-i �'j�(� f, c�c� :-�;� �.,� cl <br /> (STA� ���c� �ca� $ �9�L���.� �'ti1 SI��G� ; 7�� � rv�vs��� <br /> '13 C� T�YI� o v�c� ��v yr (T�o v.�� t3 `f �u�Q T , o?�,�� - <br />