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- c ` <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> �"1`� � 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 installing the following: '��t �� �'�`"`�`is <br /> A. Tanks: k Precast Concrete Other Manufacturer n� S <br /> Tank Capacities: 1) /52� gal. 2) gal 3) gal <br /> B. Pump Station (if required) C�S� <br /> Pump make& model �,'o+�-� ��� (�c�t,�- (attach pump curve& <br /> literature); system design requires gpm at feet of head. <br /> High water alarm make& model . Outside <br /> electrical work to be completed by installer electrician other. <br /> C. Treatment System: .��� ����, ���`���5 <br /> `l�i��_Trenches: s.f. Mound <br /> Depth of rock below pipe " Rock bed dimensions ' x ' <br /> _l�_Drop Boxes Sand bed dimensions ' 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 regulations of the State <br /> of Minnesota,and certifies that all statements made on this application are complete,true and conect. <br /> Signature of Applicant `� 1 Y Date: S'? s -�'3 <br /> MPCA License No. �� ��`7 <br /> ------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval Denial <br /> Reviewer: Date• � <br /> Reason for Denial: <br />