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� � <br /> SEPTIC 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 �IAIL i�AYMEATT WITH THIS APPLICATION <br /> �****��****��tt*�*�r�e*���***����r��*********�********�**:**���***��******�**** <br /> NOTE: Applicant must initial ail spaces. Fill in aIl appropriate blanks, <br /> check all appropriate boxes. <br /> Ini, 1 <br /> l. I have received a copy of the system design including the <br /> City of Orono Septic System Approval Cover Sheet. <br /> 2 . I wili be installing the following: <br />� A. Tanks: =S Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) �%�'' gal. 2 ) �1 gal. 3 ) �C'���� gal. <br /> B. Pump Station (if re uired <br /> Pump make & model���,/ .����~ (attach pump curve & <br /> literature) ; system design requires �gpm at ,i feet <br /> of head. High water alarm make & model�,�/�� �- .�i: ���;%�;�C� - <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 /> Trenches: s.f . � Mound <br /> Depth of rock below pipe " Rock bed dimensions ��'x�' <br /> Drop Boxes Sand bed dimensions 'x ' <br /> Distribution Box Pressure Dist. Pipe Diam. I�.�" <br /> Manifold Pipe Diam. �_" <br /> D. Final Cover/Topsoil. to be: borrowed from site <br /> (show location on site plan) <br /> � trucked in <br /> **�*******�**�***********���**********���*�***�**�*t***#****************�** <br /> The undersigned hereby applies to the City of Orono for issuance of a <br /> se�tic system installation permit, agrees to ao all work in strict <br /> accordance with the ordinances of the City and the regulations of the State <br /> of Minnesota, and certifies th all statements made on this application <br /> are complete, true and correc . <br /> �__., ,� /- <br /> � � � <br /> Signature of Applicant• ,�.,,,�✓ Date: � -�-'`- / 2-- <br /> MPCA Certification No. : �j�j <br />