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;EPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit Type & Fees (check one) <br /> � New Construction, Ful.l System $100 . 00 . . . . . . . . . . . . . . <br /> Repair or Replace Existing System $50 . 00 . . . . . . . . . . . . . <br /> 0 . 50 State surcharge added to above permit fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYM�?NT WITH THIS APPLICATION <br /> a*******t*tf*******�****�******�***�*********t*******�***�**********�****** <br /> �OTE: Applicant must initial aIl spaces. Fill in aI.I appropriate blanks, <br /> check all appropriate boxes . <br /> Initial <br /> `� �� . 1. I have received a copy of the system design including the <br /> City of Orono Septic System Approval Cover Sheet. <br /> '� .� 2 . I will be installing the following: <br /> A. Tanks: ��_Precast Concrete Other Manufacturer `� � �..,�. , a ._, <br /> �ZSc � <br /> Tank Capacities : 1) � Z`�� gal . 2 ) ��� gal. 3 ) b'F�. gal. <br /> ��_ � �<_,<. <br /> B. Pump Station (if required ) � <br /> Pump make & model Z� � � ` � ; `���- . _,�� (attach pump curve & <br /> literature) ; system design requires �gpm at .� �� feet <br /> of head. High water alarm make & model � 4, „� c-,���., ,.., <br /> O�tside electrical work to be completed by installer <br /> j< electrician other Inside electrical work <br /> must be completed by electrician. • <br /> C. Treatment System: <br /> Trenches: s.f. x Mound <br /> Depth of rock below pipe " Rock bed dimensions �l_s'x Ic ' <br /> Drop Boxes Sand bed dimension���5 �, ' x�,_' <br /> Distribution Box Pressure Dist. Pipe D�.am. i%Z � " <br /> Manif old Pipe Diam. Z " <br /> D. Final Cover/Topsoil to be: x borrowed f rom site <br /> (show Iocation on site plan) <br /> trucked in <br /> �*****���***t�*******��#�*�****�#**#****#********t*#*******************�**t <br /> mhe undersigned hereby applies to the City of Orono f or issuance of a <br /> septic system installation permit, agrees to do all work in strict <br /> accordance with the ordinances of the City and the regulations of the State <br /> �i Minnesota, and certifies that all statements made on this application <br /> are complete, true and correct._---7 <br /> %J�� <br /> 3i ature of A licant: ' � �� <br /> sn rr 1 �-�!" �.�/ >at�: C. - `�- `t ; <br /> :�PCA Certification No. : � � � � � <br />