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Soa-24-20]2 11:47a� Fro�-CITY OF ORONO +9522494616 T-173 P.p031a73 �-231 <br /> Np�'E; Applica.nt n�ust in.itial all spaces. Fill im all appropriatc blanks and check ai!appropriate <br /> boxes. <br /> 1. Y have received a copy of thc systesz� design including the City of 4ronc� Septic <br /> � Systcm Appra�vai Covei Sheet. <br /> 2. I will be installing the foliowing: ���r ���er �"`s <br /> ''�� A Tacks: .3 P['CCBSL COACfe� <br /> T3Cl�C C&j73Clt.lGS: 1� /��4, $E.1. �� ���Z� �� S� <br /> T�u sk- '�r��' ��"�'� <br /> B. Fu�p Statioa(if required) _ ��3� (attay� pump�urve& <br /> pup�:p m�ice&model �� �`�� <br /> �.�� m at �v feet of head, <br /> litsrature); system design r quires � . qutside <br /> High water alarm make 8c model � �ns�taller ���electrician other. <br /> electric�l work to be compEeted by <br /> C. Trc�tm�ut Syst�m: �ouad <br /> Tcenches: s.f. , s <br /> Depth of rock belaw pipe�" Rock bed dimensions �`O x ' � ' <br /> Drap 8oxes Sa.nd bed dimens�or�s�-' � '3 ' <br /> . D i stribution Box P�essura Aist.Pipe Diam.� �� <br /> Manifoid Pipe T�ia,m. � <br /> U, �'inal Cover/Topsoil to be: _�. borrowed from site <br /> (show location on s�te plan} <br /> � <br /> trucked i.n <br /> The uadersigmed hereby appl'ses to the City of Orono for issuanca of a septic system insta!latioA permit� <br /> agroes to do all wor9c in svict accordap.ce with ardinances af the�o ��camP etea ttut aad coaact <br /> o����ots,and cezcifies that all statexnents cnade on thi pp �� <br /> �� / Date: � �``� d�' <br /> gignature of Applic�nt <br /> Iv1,pCA License No, � <br /> ' .�.�_�___„�.�._.�--_._____-___..�.__�__ <br /> ___..___�-----�----- <br /> Staff�ttview: APProval Deuisl <br /> � Dafie: <br /> �evlewer: <br /> Rea�on [or Denial: <br />