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>EPTIC SYSTEM PF.RMIT APPI�ICA�`ON - 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 />� � <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYMLNT WITH THIS APPLICATION <br /> b*�****�tt�*t*****f�t*******�*****�***#*******�**�**�**#***�f****�***f***## <br /> �OTE: Applicant must initial alI spaces. Fill in all appropriate blanks, <br /> check all appropriate boxes. , <br /> Initial <br /> �� <br /> l. I have received a copy of the system design including the <br /> City of Orono Septic System Approval Cover Sheet. <br /> ��� � ����� <br /> 2 . I will be installing the following: ...-� / , <br /> A. Tanks. Precast Concrete Othe��ufacture /L•-C�� <br /> ,�. � � ���-� <br /> Tank Capacities : 1 ) ��gal. 2 ) ���g 1. 3 ) cral. <br /> B. Pump Station (if required) <br /> Pump make & model (attach pump curve & <br /> literature) ; system design requires gpm at f eet <br /> of head. High water alarm make & model <br /> Outside electrical work to be completed by _installer <br /> electrician other Inside eiectrical work <br /> must be completed by electrician. • <br /> C. Treatment System: <br /> � Tren che s: � (i� s.f. Mound <br /> Depth of rock below pipe / Z " Rock bed dimensions 'x ' <br /> Gf 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�*****t�*****�**#********��r�***t*�*�f**t�**f*******t*****�** <br /> ':'he 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 /> :�f Minnesota, and certifies that all statements made on this application <br /> are compiete, true and correct. <br /> � _ <br /> 3ignature of Applicant: �iG��� ��� Date: � C.� i �� <br /> � <br /> _iPCA Certification No. : � c� � � <br />