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� <br /> NOTE: Applicant rriust initial all spaces. Fill in al1 appropriate blanks, check all appropriate <br /> boxes. . <br /> 1. I have received a copy of the system desi�n includinJ the Ciry of Orono <br /> Septic System Approval Cover Sheet. � <br /> .2. I �viII be installin� the followinQ: <br /> A. Tanks: Precast Concrete _ Other Manufacturer o <br /> Tank Capacities: 1) �� 0�7 gai, 2) vcrp �al. ;) �al. ��`� <br /> B• Pump Station (if required) <br /> Pump make & model (attach pump curve & <br /> literature); system desi�n requires opm at feet of head. <br /> , Hi�h tva[er alarm make & model Outside . <br /> • electrical work to be completed by installer eleccrician <br /> ocher . Inside electrical work must be completed by <br /> eleccrician. <br /> C. Tr�tment System: <br /> s Trenches: 3�r/ s,f. Mound <br /> Dep_th of rock below pipe$=�• .2 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: �_ borrotved from site <br /> (show location on site pla�) � <br /> irucked in <br /> The undersi�ned hereby applies to the Ciry of Orono for issuance of a septic system installation <br /> permit, a�rees to do all work in strict accordance with the ordinances of the City and the <br /> reguIations of the State of Minnesota, and certifies that all statements made on this application <br /> are complete, true and correct. <br /> Si�natureofApplicant•_ Date: l—��� ����� <br /> MPCA Certification No.: l �'�� - <br /> Staff Review: Appr v D �� � <br /> ' .-J�" <br /> ReFietiver: � , � � ,� r. � <br /> �� Date: � ��" <br /> Reason for Denial: <br />