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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all apprapriate <br /> boxes. <br /> � 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: �,��r��us5 <br /> A. Tanks: Precast Concrete 7� Other Manufacturer <br /> Tank Capacities: 1) aal. 2) gal 3) gal <br /> B. Pump Station(if required) <br /> Pump make& model ����f���2 (attach pump curve& <br /> literature); system design requires 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:1�,�,l�fiN�"`' <br /> �_Trenches: s.f. Mound <br /> Depth of rock belo�v 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: �_ 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«-ith 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 correct. <br /> Signature ofApplicant , ,�-� '�� Date: /�L�-f� <br /> Ml'CA License No. �� <br /> StaffReview: Approval � Denial <br /> , <br /> Reviewer: ��7� � �,-.,�� Date• � C., - \ -- L� � <br /> Reason for Denial: <br />