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., �. <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> � <br /> _� 1. I have received a copy of the system design including the City of Orono Septic <br /> - System Approval Cover Sheet. <br /> � %-S .:� 2. I will be installing the following: <br /> V 5.=�:1� ��, s�:-.f, TankSCapacities:ecijt Concret�al 2� Other ga1Manufacturer al <br /> ) g <br /> B. Pump Station(if required) <br /> Pump make&model (attach pump curve& <br /> literature); system design requires gpm at feet of head. <br /> High 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 fCO ' x�7. ' <br /> Drop Boxes Sand bed dimensions ' x ' <br /> � " �� <br /> Distribution Box Pressure Dist. Pipe Diam.�_ <br /> Manifold Pipe Diam. � " <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 /> a�rees to do all work in strict accordance with ordinances of the City and the regulations of the State <br /> of Ivlinnesota,and certifies that all statements made on this application are complete,true and correct. <br /> Signature ofApplicant � Date: � ��� � �3 <br /> MPCA License No. `d�/�� <br /> ------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval /`� Denial <br /> _ � �Reviewer: ����'C J �,t Date• �� ( � ��� <br /> Reason for Denial: <br />