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l , � <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes� <br /> /G/ 1. I have received a copy of the s stem desi n includin the Ci of Orono Se tic <br /> Y g g �Y P <br /> System Approval Cover Sheet. <br /> � 2. I w-ill be installi�the following: <br /> A. Tanks: i� Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) i z 5 c' gal. 2) 1�� c G gal 3) gal <br /> B. Pump Station (if required) <br /> Pump make& model (attach,��ump curve& <br /> literature); system design requires LI Z 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�' x � ' <br /> Drop Boxes Sand bed dimensions �' x Jo�' <br /> Distribution Box Pressure Dist. Pipe Diam. '2 " <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 /> agrees to do all work in strict accordance with ordinances of the City and the regulations of the State <br /> of Minnesota,and certifies t t 11 sta e��s-nrati�n t � pplication are complete,true and correct. <br /> / �. <br /> SignatureofApplicant � '�'f 2 Date: lc� � �' <br /> MPCA License Na � ��� <br /> �. � <br /> Staff Revie�v: �pproval `•� Denial <br /> Reviewer: -�i.�r�-_��.�--- Date: 1 l� `� — �� <br /> Reason for Denial: <br />