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NOTE: Applicant must initial all spaces. Fill in all appropriate 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 Sheet. <br /> 2. I will be installin� the followinQ: - � � <br /> A. Tanks: �Precast Concrete � Other Manufacturer������`�� <br /> Tank Capacities: 1)iZ`Sa gai. 2) /�;c:� gal. 3) ?aI. <br /> B. Pump Station (if required) <br /> Pump make & model � � r��- �'�'--� ��a (attach pump curve & <br /> literature); system desigr. requues �^ apm at � feet of head. <br /> Hijh water alarm make & model ,�r v�-/� �1���z� 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 lO 'x�' <br /> Drop Boxes Sand bed d'unensions.��'xjl�; ' <br /> Distribution Box Pressure Dist. Pipe Diam. /%1 " <br /> Maniford Pipe Diam. � " <br /> D. Final Cover/Topsoil to be: /\ borrowed from site <br /> (show location on site plan) <br /> trucked in <br /> The undersijned hereby applies to the City of Orono for issuance of a septic system installation <br /> permit, a�rees 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 /> ( � <br /> Si�natureofApplica :- G �� ; Date: �" z� ^ 9 7 <br /> MPCA Certification No.: �� � <br /> Staff Review: Approval Denial <br /> � Re`-iewer: Date: <br /> Reason for Denial: <br />