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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> ��Y�'`� 1. I have received a copy of the system design including the City of Orono � <br />� Septic System Approval Cover Sheet. <br /> Z � ` � _ 2. I will be installing the following: � <br /> A. Tanks: �Precast Concrete Other Manufacturer -� 1 S <br /> Tank Capacities: 1) � gal. 2) Z� s v gal• 3) j Z3v gal. <br /> B. Pump Station (if required) � <br /> Pump make & model � �> S (attach pump curve & <br /> �-�u� literature); system design requires � �i_ gpm at / � feet of head. <br /> High water alarm make & model e�v,�,��c�� Outside <br /> electrical work to be completed by installer electrician�_ <br /> other Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. �_ Mound <br /> _ Depth of rock below pipe " Rock bed dimensions /J 'x ��' <br /> Drop Boxes Sand bed dimensions 3�' 'x /zt� <br /> Distribution Box Pressure Dist. Pipe Diam. /l� " <br /> Maniford Pipe Diam. 2 " <br /> D. Final Cover/Topsoil to be: � bonowed 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, agrees 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 /> SignatureofApplicant: J�C,�-v�2�-l' 0� C.��t'ii�vL- Date: ��- �- �`1 <br /> MPCA Certification No.: <br /> Staff Review: Approval T� Denial <br /> � j�_ ����� <br /> Reviewer: �1.0 G � Date• <br /> Reason for Denial: . <br />