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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> x" 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 installin�the following: <br /> A. Tanks: Precast Concrete Other Manufacturer S.�p��ei.� <br /> Tank Capacities: 1) �- �� gal. 2) %����� �al 3) jal <br /> B. Pump Station (if required) <br /> Pump make& model x hr (attach pump curve& <br /> literature); system desi�n requir gpm 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: �J k��y <br /> X Trenches:�s.f. Mound <br /> Depth of rock below pipe " Rock bed dimensions ' x ' <br /> Drop Boxes Sand bed dimens�ons ' x ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Manifold Pipe Diam. " <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 /> agrees 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 /> Signature ofApplicant �� Y��f- Date: "��S-o � <br /> NIl'CA License No. � C:, 3 ? <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval ���,' Denial <br /> �"��.��.��%���� ? - �-� r v-� <br /> Reviewer: Date• <br /> Reason for Denial: <br /> � 5 ,��- A ��P,� (�jt.1 � ; '� j,� '���J�OJS C :-1 °-( :3^n S 'p���a� <br /> � <br /> � ��� �v ( ��"��1� � <br />