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�► <br /> r - <br /> NOTE: 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 design including the City of Orono Septic <br /> System Approval Cover Sheet. <br /> � <br /> �� � ;'� -• 2. I will be installin�the following: <br /> A. Tanks: � Precast Concrete �_Other Manufacturer <br /> Tank C pacities: 1) •� "'��� �al. 2) l;L'�='�� � �al 3) ,����� �, : gal <br /> �r�" <br /> B. Pump Station (if required) <br /> Pump make & model �' �� LI��'� (attach pump curve& <br /> literature); system desijn requires Sr, ' gpm at / �'. � feet of head. <br /> High water alarm make &model _ �1��j ,�/�r; � L"t_ . 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 �C' <br /> Drop Boxes Sand bed dimensions �' Y�' <br /> Distribution Box Pressure Dist. Pipe Diam. -� " <br /> Manifold Pipe Diam. '?— " <br /> D. Final Cover/Topsoil to be: borro�ved 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 permit, <br /> a�rees to do all work in strict accordance with ordinances of the City and the regulations of the State <br /> of Nlinnesota,and certifies that all statements made on this application are complete,true and correct. <br /> � <br /> , �--- , -, <br /> Si�natureofApplicant `�'��` ��'� Date: ���� – ���G� <br /> � � <br /> NIl'CA License No. ���� <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> � <br /> Staff I�ev�e�v: App�oval +� I)eni�i <br /> �eviewer: D�te• / � '� �-I "��o <br /> Reaso� for �enaa�: <br />