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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <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 installinQ the followin�: �S <br /> A. Tanks: �recast Concrete Other Manufacturer L'�u�C, <br /> Tank Capacities: 1) ��x�s(, ti�al. 2) �`�c��;,�.G�al 3) ���v �al <br /> (� r�o <br /> B. Pump Station (if required) _ <br /> Pump make& model ��L'� S (attach pump curve& <br /> literature); system desijn requires �f v gpm at �`'s ' feet of head. <br /> High water alarm make & model �N-��R sc��-,.�i��' . Outside <br /> electrical work to be completed by installer��electrician other. <br /> C. Treatment System: <br /> Trenches: s.£ � Mound <br /> Depth of rock below pipe " Rock bed dimensions �� ' x �Z' <br /> Drop Boxes Sand bed dimensions � O ' x 4Z ' <br /> Distribuiion Box Pressure Dist. Pipe Diam. i• S " <br /> Manifold Pipe Diam. � � o " <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 rejulations of the State <br /> of Nlinnesota,and certifies that all stateme s made on this application are complete,true and correct. <br /> SignatureofApplicant �- Date: � l� 4 � <br /> MPCA License No. <br /> `� �js <br /> ��f�,,ti I�S L..� , � 1 �P C �1 P C" iL�� �� �J� ��—cT�"�jl.,ti1 C SS <br /> J��. c� 1"3,��G(c'S �' �"!/L��' <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> c�� �S��cefi,�-�, <br /> Staf',f Revie�v: App�ova� Denial <br /> Reviewer: D�te• �'— �� `v�P <br /> �e�soa� for �enia�: <br />