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_ � <br /> , <br /> . <br /> I�'OTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> `'� 1. I have received a copy of the system desi�n including the City of Orono Septic <br /> System Approval Cover Sheet. <br /> 2. I�vill be installinj the following: <br /> A. Tanks: _�Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) �UOU gal. 2) jC%�; G gal 3) gal <br /> B. Pump Station (if required) <br /> Pump make& model____� `� /�� /��C ►'�' �� (atta�h pump curve& <br /> literature); system design requires �`o gpm at � -, feet of head. <br /> High water alarm make& model . Outside <br /> electrical work to be completed by in�taller >C' 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 ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> l�fanifold Pipe Diam. " <br /> D. Final Cover/Topsoil to be: bonowed from site <br /> (show location on site plan) <br /> trucked in <br /> The undersi;ned hereby applies to the Ciry of Orono for is�uance ofa septic system installation permit, <br /> a�rees to do all work in strict accordance with ordinances of the City and the re�ulations of the State <br /> of l�linnesota,and certifies tY�at all statements znade on this application are complete,true and correct. <br /> / <br /> Si�natureofApplicant ��� =G � Date: '�i- �—c'� <br /> J� , � <br /> MPCA License I�To. ���j <br /> ------------------------------------------------------------------------------------------------------------------------- <br /> StaffRevie�ti•: Approval_� Denial <br /> Revie�ver: �� � Date: � �- ��d � <br /> Reason for Denial: <br /> X - s-i a�-� �ar���c� 9ra��ec� �-v 9° `'�'��, �� to SO � -��o�. �v��-I�,,.J <br /> �' 1 0 �EC�" �C�� �'J V .`u r - . <br /> ` 5 _ 'i 1•;5 ►5 only ��I�c� -�-a ��� ,,c•� �au„a � <br />