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NOTE: Applicant must initial all spaces. Fill in a11 appropriate blanks, check all appropriate <br /> boxes. . <br /> � 1. I have received a copy of the system desijn includin� the Ciry of Orono <br /> Septic System Approval Cover Sheet. � <br /> � .2. I �vill be installin� the followinQ: <br /> A. Tanks: Precast Concrete _ Other Manufacturer�_ <br /> Tank Capacities: 1) �GGU ;ai. 2) S�G� �al. �) f 1 fJ« - <br /> ^ a , <br /> B• Pump Station (if required) <br /> Pump make & model (attach pump curve & <br /> � Iiterature); system design rzquires opm at feet of head. <br /> Hi�h water alarm make & model Outside <br /> � electrical work to be completed by installer eleccrician <br /> ocher . Inside electrical work mus[ be completed by <br /> electrician. <br /> C. Treatment System: <br /> JC Trenches: �� 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 /> Maniford Pipe Diam. " <br /> D. Final Cover/Topsoil to be: �_ borrowed from site <br /> (show location on site pla�)- <br /> trucked in <br /> The undersi�ned hereby applies to the Ciry of Orono for issuance of a septic system installation <br /> permit, agrees to do all work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minnesota, and cenifies chat all statements made on this application <br /> are complete, true and correct. <br /> Si�natureofApplicant: � Date: /— �— ..2.� —�� <br /> MPCA Certif cation No.: ��� - <br /> � <br /> Staff Reviesv: Appro al �, Denial <br /> . � <br /> Rerietiver: � ���� (� � <br /> �" ,--� Date: � � <br /> Reason for Den.ial: <br />