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;EPTIC SYSTEM PERMIT APPLICATON — PAGE 2 <br /> Permit Type & Fees (check one) <br /> � New Construction, Full 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 PAYMLNT WITH THIS APPLICATION <br /> b*�f*****t#*��******f******�*:�**********t*******�***�***********�*t#*#**#* <br /> dOTE: Applicant must initial all. spaces. Fill in all appropriate blanks, <br /> check all appropriate boxes. <br /> Initial <br /> OC��� 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: n�`'���"`�'i� <br /> A. Tanks: �Precast Concrete Other Manufacturer !/�,c.3.c,c%,:%'� <br /> Tank Capacities : 1 ) c,�/ V� gal . 2 ) �2/ �U gal . 3 ) J��� gal. <br /> �a��;�,,,.. <br /> B. Pump Station (if required),., c��. hLAy^���� c,,c,fi�l G���k �(�:`"� '� � <br /> ��--s t�t 1 e. �� <br /> Pump make & model S/��0 ; �'' �,;�tr (attach pump curve & <br /> literature) ; system design requires �gpm at 2 3 feet <br /> of head. High water alarm make & model `T,,..�' S�u.� <br /> Outside electrical. work to be completed by installer <br /> �electrician other Inside electrical work <br /> must be completed by electrician. • <br /> C. Treatment System: <br /> � Tren che s: ,7 2� s.f. � Mound <br /> �De th of rock below pipe lZ " Rock bed dimensions ' x ' <br /> Drop Boxes Sand bed dimensions ' x ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Manifold Pipe Diam. " <br /> D. Final. Cover/Topsoil to be: � borrowed from site <br /> (show location on site plan) <br /> trucked in <br /> �****#f*#***************************�*�********�***#******�*t*************� <br /> mhe undersigned hereby applies to the City of Orono for 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 /> o= Minnesota, and certifies that aIl statements made on this application <br /> are complete, true and correct. <br /> Signature of Appiicant: �.,�u.-f� ��,��,- Date: `(%�f y" �t� <br /> _dPCA Certification No. : =�l (z�j� � � <br />