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NOTE: Applicant must initial all spaces. Fill in al1 appropriate blanks and check a11 appropriate <br /> boxes. <br /> /� 1. I have received a copy of the system design includin� 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 <br /> Tank Capacities: 1) /5�� gal. 2) �o�v jal 3) �al <br /> B. Pump Station(if required) <br /> Pump make& model ��., (attach pump curve& <br /> literature); system desijn requires jpm at feet of head. <br /> Hi�h water alarm make &model . Outside <br /> electrical work to be completed by installer electrician other. <br /> C. Treatment System: � <br /> �_Trenches: �^��'��°s�' 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 Pipe Diam. " <br /> D. Final Cover/Topsoil to be: borro�ved 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 /> ajrees to do all work in strict accordance with ordinances of the City and the regulations of the State <br /> of l�Iinnesota,and certifies that all statements made on this application are complete,true and correct. <br /> Signature ofApplicant � % Date: �-S'- �% `? <br /> NLPCA License No. Z� 3 ? <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> / ,� <br /> � <br /> St�ff�tev�e�v: Appa�ova� ,�' I�eniai <br /> Reviewer: � D�te• �� f' �� <br /> �easo� �'or �eniai: <br />