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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 /> 2. I will be installing the following: <br /> A. Tanks: � Precast Concrete Other Manufacturer DA��='�'� <br /> Tank Capacities: 1) s Cy gal. 2) / �� gal 3) �,�� gal <br /> B. Pump tation(if required) <br /> Pump make 1 (attach pump curve& <br /> literature); system design req ' eet of head. <br /> High water alarm make & mo ide <br /> electrical work to be p eted by installer electrician other. <br /> C. Treatment System: � <br /> Trenches: s.£ Mound <br /> Depth of rock below pip� " Rock bed dimensions /0 ' x Cn�' <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 /> � �(s�iow location on site plan) <br /> �� trucked in <br /> The undersigned hereby applies to the City of Orono for issuance of a septic system installation permit, <br /> agrees to do all work in strict accordance with ordinances of the City and the regulations of the State <br /> of Minnesota,and certifies that all statements made on this application are complete,true and correct. <br /> Signature of Applicant Date: <br /> MPCA License No. <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> V <br /> Staff Review: Approval Denial <br /> Reviewer: �, � ��,c,L, ��� Date• I 1 — ( 3--G7 <br /> —�,._—.f <br /> Reason for Denial: <br />