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NOTE: Applicant must initial all spaces. Fill in al1 appropriate blanks and check aIl appropriate <br /> boxes. <br /> ' � 1. I have received a copy of the system design includin� the City of Orono Septic <br /> System Approval Cover Sheet. <br /> 2. I will be installi e followin�: <br /> �X�5,�_ A. anks: Precast Concrete Other Manufacturer <br /> '�ank Capacities: 1) / 3vv jal. 2) !3C�c:3 �al 3) �.3C�v �al <br /> B. Pump Station (if required) <br /> Pump make&model (attach pump curve& <br /> literature); system desijn requires gpm at feet of head. <br /> High water alarm make &model . Outside <br /> elec�ical work to be completed by installer electrician other. <br /> C. Treatment System: �e�1 p �� L� i3�� <br /> Trenches: s.£ � �" � � Mound <br /> Depth ck b pipe " Rock bed dimensions �O ' x �� ' <br /> D o Sand bed dimensions ' x ' <br /> Distribution Box Pressure Dist. i " <br /> ' Manifold � iam. " <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 /> a�rees to do all work in strict accordance with ordinances of the City and the re�ulations of the State <br /> of Nlinnesota,and certifies that all statements made on this application are complete,true and correct. <br /> __.. _ .___---___. <br /> Y I ` � � <br /> Si�nature of Applicant Date: �P � � <br /> MPCA License No. �Q `C �J <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staf�'iZev�e�`: Appe�ova� �eniai <br /> Revie�ver: D�te: � � � �� '��� <br /> �eason fo; �enia9: <br />