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t � , r <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> �,i�'� 1. I have received a copy of the system desijn including the City of Orono <br /> � Septic System Approval Cover Sheet. <br /> 2. I will be installing the following: <br /> A. Tanks: � Precast Concrete _ Other Manufacturer �u'�/��� <br /> Tank Capacities: 1) 3�.�= gai. 2) / 3��� gal. 3) 3��� gal. <br /> B. Pump Station (if required) <br /> Pump make & model �� /�l f J��� (attach pump curve & <br /> literature); system desi�n requires �'� gpm at J '' 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. Treatment System: \,�, <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. / '�z " <br /> Maniford Pipe Diam. � " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> ?�� trucked in <br /> The undersi;ned 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 /> regula[ions of the State of Minnesota, and certifies that all statements made on this application <br /> are complete, true and conect. <br /> ) <br /> .r ) / C -� <br /> Si�natureofApplicant: ���-�� f� CJ�C��� Date: l �%�� �' <br /> MPCA Certification No.: �-S �� <br /> Staff Review: Approval �_ Denial <br /> . � p <br /> Revie�ver: - _� ,c �� ,:-----�. Date: /��--� <br /> Reason for Denial: <br />