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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 installing the follo�vin�: <br /> A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) gal. 2) gal 3) gal <br /> B. Pump Station (if required) <br /> Pump make& model (attach pump curve& <br /> literature); system design requires gpm at feet of head. <br /> Hi�h water alarm make & model . Outside <br /> electrical work to be completed by installer electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe " Rock bed dimensions ' x ' <br /> Drop Boxes Sand bed dimensions ' x ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Manifold Pipe Diam. " <br /> D. Final Cover/Topsoil to be: borro�ved 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 /> agrees to do all work in strict accordance with ordinances of the City and the regulations of the State <br /> of Nlinnesota,and certifies that all statements made on this application are complete,true and correct. <br /> Signature of Applicant Date: <br /> l�IPCA License No. <br /> � ; �, �� ; �� � i � <br /> ����i ��� � �� �.�� � �- � �_ .�`� <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval / Deniai <br /> `� p�� � � �,, ,-_ <br /> Reviewer: ��c� ''I��— ��Z�i- + Date: / � '•J <br /> iZeason for Denial: <br />