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EPTIC SYSTEM PERMIT APPLIGATON - PAGE 2 ' <br /> Permit Type & Fees (check one) <br /> _� New Construction, Full System $100 . 00 . . . . . . . . . . . . . . <br /> Repair or Replace Existing System $50 . 00. . . . . . . . . . . . . <br /> 0 . 50 State surcharge added to above permit fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYMENT WITH THIS APPLIGATION <br /> �.*�*****t�##�****��***�t�*********��*�********�**�**********�****�**�***�** <br /> �OTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br /> check ail appropriate boxes. <br /> Initial <br /> � � <br /> dL(� l. I have received a copy of the system design including the <br /> City of Orono Septic System Approval Cover Sheet. <br /> � <br /> �;K,C? 2 . I will be installing the following: , <br /> A. Tanks: � Precast Concrete Other Manufacturer�J <br /> Tank Capacities : 1) /ll���' gal . 2 ) j��L�' gal. 3 ) /vc��'� gal. <br /> B. Pump Station (if required) <br /> Pump make & model OS�' j � (attach pump curve & <br /> literature) ; system design requires 3s� S gpm at %3, � feet <br /> of head. High water alarm make & model �Tn�St��i�. <br /> Outside electrical work to be completed by installer <br /> �electrician other Inside electrical work <br /> must be completed by electrician. <br /> C. Treatment System: <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe " Rock bed dimensions I� 'x SZ ' <br /> Drop Boxes Sand bed dimensions yU ' x�' <br /> Distribution Box Pressure Dist. Pipe Diam. ' �r /Z " <br /> Manifold Pipe Diam. 2 " <br /> D. Final Cover/Topsoil to be: �C borrowed from site <br /> ( show location on site plan) <br /> trucked in <br /> #*****f***�********#********�*�******�**#******�:*t******�**�**********�*** <br /> `"he undersigned hereby applies to the City of Orono for issuance of a <br /> septic system installation permit, agrees to do aIl work in strict <br /> accordance with the ordinances of the City and the regulations of the State <br /> of Minnesota, and certifies that all statements made on this application <br /> are complete, true and correct. <br /> Signature of Applicant: ✓���-X-��` ��(/u�c1 Date: �(� - �S � �Z= <br /> _KPCA Certification No. : �✓Yt t'��('� � <br />