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S$PTIC SYSTEM P$RMIT APPLICATON - PAGE 2 <br /> . � <br /> Permi.t Type � Fees (check one) <br /> New Construction, Full System $75. 00. . . . . . . . . . . _. - . .� . . <br /> Replace Existing System (1 or more new tanks & drainfield) .r$50.00.\'�. . <br /> Partial Replacement (replace just tanks or just drainfield) $30. 00. . . <br /> $0.50 State surcharge added to above permit fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYMENT WITH THIS APPI�ICATION <br /> ***:*�**********************�********��**********************�t************ <br /> NOTS: ApFlicant must initial all spaces. Fill in all appropriate blanks, <br /> check all appro�riate boxes. <br /> Initial <br /> i� <br /> �t'�7/ 1. I have received a copy of the system design including the <br /> ;,, <br /> City of Orono Septic System A�proval Cover Sheet. <br /> �':�' 2. I will be installing the following: f, <br /> A. Tanks: �Precast Concrete Other Manufacturer ,�'�L" �-' <br /> Tank Capacities: 1 ) uZ?Q gal. 2 ) ;z��C� gal. 3 ) gal. <br /> B. Pump Station (if required) <br /> Pump make & model (attach pump curve & <br /> literature ) ; system design requires gpm at feet <br /> of head. High water alarm make & model <br /> Outside electrical work to be completed by installer <br /> _electrician other Inside electrical work <br /> must be completed by electrician. � <br /> �__h ��,�.,� .— {`.3 �. /o � i <br /> C. Treatment System: ������- �-r�5 S � �' � <br /> � Trenches : � �5" s.f. Mound <br /> Depth of rock below pipe " Rock bed dimensions 'x ' <br /> Drop Boxes Sand bed dimensions 'x ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Manifold Pige Diam. " <br /> D. Final Cover/TopsoiT to be: �borrowed from site <br /> (show location on site plan) <br /> trucked in <br /> �***#***�***********�*****#**********#**�***�***************#**�***��****�* <br /> The undersigned hereby applies to the City of Orono for issuance of a <br /> septic system installation permit, agrees to do all work in strict <br /> accordance with the ordinances of the City and the regulations of the State <br /> of Minnesota, and certifies that all statements made on this application <br /> are comp lete,. true and correct. <br /> -.----, <br /> ' � _ <br /> , % ���''��� � , <br /> Signature of AFplicant: � �, _,.�r� Date: � �t <br /> MPCA Certification No. : �J'��, � � <br /> —� � <br /> � <br /> i <br />