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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 ! _ <br /> Permit Type & Fees (check one) <br /> _ __ New Construction, Full System $75. 00 . . . . . . . . . . . . . . . . . . <br /> Replace Existing System (1 or more new tanks & drainfield) $50 . 00 . . . <br /> ,�Partial Replacement (reFlace just tanks or just drainfield) $30 . 00 . . . <br /> $0. 50 State surcharge added to above �ermit fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYMENT WITH THIS APPLICATION <br /> �**************�*******************************�****�********************** <br /> NOT$: Ap�licant must initial all spaces. Fill in all appropriate blanks, <br /> check all appro�riate boxes. <br /> Initial <br /> l. 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 ) �l�J 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 dimensions 'x ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Manifold Pi�e Diam. " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> trucked in <br /> ****************�**********�*��**************�****�****�***********�******* <br /> The undersigned hereby applies to the City of Orono for issuance of a <br /> septic system installation 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 statements made on this application <br /> are comp lete, true and correct. - - � <br /> -�"" %��'%� <br /> Signature of Applicant: ,�� ,�i� Date: <br /> � / <br /> MPCA Certification No. : <br /> 1 S�'� ` � j,'/ <br /> �/l� <br /> � � <br />