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' � - � <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> , �. <br /> (, . <br /> � l. I have received a copy of the system desi�n including the Ciry of Orono Septic <br /> .� "�~ System Approval Cover Sheet. <br /> 2. I will be installin�the following: <br /> A. Tanks: _�recast Concrete Other Manufacture �4 rw �`n1 <br /> TankCapacities: 1) Is7x� jal. 2) �5(�� gal 3) j�� �al <br /> B. Pump Station (if required) <br /> Pump make & model ���jD// (attach pump curve& <br /> literature); system desi�n requires �Z jpm at -3�feet of head. <br /> High water alarm make & model 5� ' �.�►r b�s . Outside <br /> electrical work to be completed by installer electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. � Ivlound <br /> Depth of rock below pipe " Rock bed dimension�U ' x 7� <br /> Drop Boxes Sand bed dimensions�f�' 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 /> The undersigned 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 Lvith ordinances of the City and the re�ulations of the State <br /> of Nlinnesota,and certifies that all statements made on this application are complete,true and correct. <br /> --7 ` <br /> Signature of Applicant �� �� Date: L�� � �� —��l� <br /> I�IPCA�icense No. � �Q <br /> ---�---------------------------------------------------------------------------------------------------------------------- <br /> / , <br /> 5�af�'�eyses��: .�p��-ov�fl � � �en��� <br /> �'�Q,,-�,os�,4a.; �-t,/����� i!�� A��atz: `_'/'�� '�(f� <br /> i <br /> ���so�i �c��� il�e3�a��: <br />