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NOTE: Applican[ rriust initial all spaces. Fill in alI apgropriate blanks, check all appropriate <br /> boxes. <br /> 1. I have received a copy of the system desi�n includin� the Ciry of Orono <br /> Septic System Approval Cover Shee[. <br /> 2. I �viIl be installinQ e followin�: <br /> A. Tanks: Precast Concrece O[her Manufacturer �..�Z,CL S <br /> Tank Capacities: 1) �ySU gaI. 2) dvc:.a gal. 3) '��oal. <br /> B- Pump Station (if required) <br /> Pump make & model �,�.�� --��']/ - ��S (attach pump curve & <br /> literature); system desi�n rzquires � opm at 2.Z-- feet of head. <br /> Hi�h �vater alarm make & model o,t �����. <br /> • ' electrical work to be completed by installer electrician <br /> ocher Inside electrical work must e y <br /> elec[rician. <br /> C. Treatment System: / <br /> Trenches: s.f. �� Mound <br /> Depth of rock below pipe " Rock bed dimensions /L� 'x ,��,�' <br /> Drop Boxes Sand bed dimensions 39 'x�' <br /> Distribution Box Pressure Dist. Pipe Diam. j .�, " <br /> Maniford Pipe Diam. Z " <br /> D. Final Cover/Topsoil to be: �✓ borrowed from site <br /> L �how location on site plan) <br /> �� trucked in <br /> The undersi�ned hereby applies to the City of Orono for issuance of a septic system installation <br /> permit, agrees to do all work in stricc accordance with the ordinances of the Ci[y 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 /> �- C/ <br /> Si;natureofAppiicant: �1�/! ,��� Date: 2�, <br /> MPCA Certification No.: q'� <br /> Staff Revie«�: Appr va � Denial <br /> � ReV-ietiver: � ����- � <br /> Date: _ <br /> Reason for Denial: <br />