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� <br /> NOTE: Applicant must irutial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> 1. I have received a copy of the system desi�n including the City of Orono <br /> Septic System Approval Cover Sheet. <br /> 2. I will be installin� the followinQ: <br /> A. Tanks: � Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) /c�� gal. 2) � �al. 3) gal. <br /> B. Pump Station (if required) <br /> Pump make & model (attach pump curve & <br /> literature); system desi�n requires gpm at feet of head. <br /> Hijh water alarm make & model Outside <br /> • ' electrical work to be completed by installer electrician <br /> other Inside electrical work must be completed by <br /> electrician. <br /> C. T�reatment System: �rc� � � ���55 <br /> Trenches: �� s.f. Mound <br /> Depth of rock below pipe " Rock bed di.mensions 'x ' <br /> � Drop Boxes Sand bed dimensions 'x ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Maniford Pipe Diam. " <br /> D. Final Cover/Topsoil to be: � bonowed 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 <br /> permit, a�rees to do all work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minnesota, and certifies that all statements made on this application <br /> are complete, true and correct. <br /> � �,- //- � � <br /> Signature ofApplicant: Date: <br /> MPCA Certification No.: ��� <br /> Staff Review: Approv 1 �� Denial <br /> �' � ^ � <br /> Reti-ie�ver: ,�--�-�' Date: jf�^��/ <br /> Reason for Denial: <br />