Laserfiche WebLink
;EPTIC SYSTEM PERMIT APPI�ICATON - PAGE 2 <br /> Permit Type & Fees (check one) <br /> New Construction, Full Syste $100. 00 . . . . . . . . . . . . . . <br /> Repair or Replace Ex ' ing stem $50 . 00 . . . . . . . . . . . . . <br /> � � <br /> 0 . 50 S ate cY�c�add rmit fees <br /> r /� SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYMENT WITH THIS APPLICATION <br /> �**�*�*�*t��*��***�************�***�****************�*�#***�*****#***�***�* <br /> �TOTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br /> check all appropriate boxes. <br /> Initial <br /> 1. I have received a copy of the system design including the <br /> City of Orono Septic System Approval Cover Sheet. <br /> 2 . I will be installing the following: <br /> A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities : 1) �` :;T�` 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 <br /> of head. High water alarm make & model <br /> Outside electrical work to be completed by installer <br /> electrician other Inside electrical work <br /> must be completed by electrician. • <br /> C. Treatment System: <br /> Trenches: s.f. Mound ) <br /> Depth of rock below pipe " Rock bed dimensions 'x ' <br /> Drop Boxes Sand bed dime�sions ' x ' <br /> Distribution Box Pressure Dist� Pipe Diam. " <br /> Manifold Pipe 'piam. " <br /> D. Final Cover/Topsoil to be: bor�owed from site <br /> ('rhow Iocation on site plan) <br /> truckked in <br /> �r#******�*****t*************�*#*#*******#**********#*******�***�***t*#***�* <br /> '"he undersigned hereby appiies to the City of Orono for issuance of a <br /> septic system instaliation permit, agrees to do all work in strict <br /> accordance with the ordinances of the City and the regulations of the State <br /> of Minnesota, and certifies that all state�nents made on this application <br /> are comp lete, true and correct. ( <br /> !� ! :r�� :--) ) � . <br /> Y '� ��-- l//);� �����✓ �_�- '/�`�` �7��� <br /> Signature of Applicant: �� 2 �i? -�- Date: <br /> _ p�y�� ...1 <br /> �-�� ^T ^ <br /> ! ' <br /> :4PCA Certification No. ;}'�� �� � � <br /> �: <br />