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NOTE: Applicanc 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 �vill be installin� the followin�: <br /> A. Tanks: �recast Concrete _ Other Manufacturer �c.�-L�S <br /> Tank Capacities: 1) �Z�� gal. 2) i ZS o �aL 3) � Z Sc� gal. <br /> B• Pump Station (if required) <br /> Pump make & model ��� L o� -�g I � -��'u� (attach pump curve & <br /> Iiterature); system desi�n requires � � gpm at /6 feet of head. <br /> Hi�h water atarm mak� .e� r,���t ��`��:> �"�,�,,,�,Fc_ vu�side <br /> • electrical work to be completed by installer eleccrician <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 l G 'x � S ° <br /> Drop Boxes Sand bed dimensions �Z'x rd�Z° <br /> Distribution Box Pressure Dist. Pipe Diam. l ;�L " <br /> Maniford Pipe Diam, z.. " <br /> D. Final Cover/Topsoil to be: `�borro�ved from site <br /> (show location on site plan) <br /> v trucked in <br /> The undersigned hereby applies to the City of Orono for issuance of a septic systerri installation <br /> permit, a;rees to do all work in stric[ accordance with the ordinances of the City and the <br /> regula[ions of the State af Minnesota azd reni.�ies that all sr",,rPmPntS �r,;��� nn, th_+c ?nnl;�ar,�� <br /> u-c ��mplete, �ruc ai�ct correcc. � � i r--�"'""- <br /> i����-�-�- <br /> Si;natureofApplicant:_��2��'7 '. ���--4,�-� Date: cf � zcz� <br /> MPCA Certification No.:_ # y� <br /> Staff Review: Ap roval � Denial <br /> Revietiver: Date: l Q 2—frC� <br /> Reason for Denial: <br />