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... , <br /> 1� <br /> NOTE: Applican[ must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> ,� �� ,� <br /> �' ;�L'� 1. I have received a copy of the system design includin� the City of Orono <br /> n Septic System Approval Cover Shee[. <br /> � � �n - , <br /> � 2. I will be installin� the followin�: <br /> A. Tanks: Precast C cr�te er Manufacturer <br /> Tank Capacities: 1) /' �al. ?�. 3) gal. <br /> B. Pump Station (if required) <br /> Pump make & model (attach pump curve & <br /> literature); system design requires gpm at feet of head. <br /> Hijh water alarm make & model Outside <br /> � ' electrical work to be completed by installer electrician <br /> other Inside electrical work must be completed by <br /> elec[rician. <br /> C. Treatment System: <br /> Trenches: s.f. � Mound <br /> Depth of rock below pipe " Rock bed dimensions _(�'x�,�' ' <br /> Drop Boxes Sand bed d'unensions ��'x �> � <br /> Distribution Box Pressure Dist. Pipe Diam. �/L" <br /> Maniford Pipe Diam. Z " <br /> D. Final Cover/Topsoil to be: � borro�ved 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 <br /> permit, a�rees to do all work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minnesota, and certifies that all statements made on this application <br /> are complete, true and correct. <br /> n <br /> Si�natureofApplicant: �� � � ��'��� Date. ;��� �� � ? � <br /> � <br /> MPCA Certification No.: � <br /> Staff Review: Approv Denial <br /> ' �-, <br /> �� q <br /> � Revie�ver: � �'�' — Date: . ���/ � — <br /> Reason for Denial: <br />