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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 installinQ the following: ���'Y'ol�� ! l� .�ee 'n��- <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); syst�m 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 Sy-stem: <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 /> T �Ji�,�'1 FK j�'Scc'� �1J�� 1`-���,C7 �/�'� r D �L���� v�. <br /> D. Final Cover/Topsoil to be: borrowed 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 Minnesota,and certifies that a statements made on this application are complete,true and correct. <br /> SignatureofApplica � Date: � -� �� <br /> N1PCA License No. <br /> Staff Review: Approval Denial <br /> Reviewer: Date• � <br /> Reason for Denial: <br />