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� y <br /> SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit Type & Fees (check one) <br /> New Construction, Ful.l System $100 . 00 . . . . . . . . . . . . . . <br /> �epair 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 /> #**�**�***#**�**��**t*�*****�*#*******�***f*�******�*******�***t*�****�**#� <br /> NOTE: Applicant must initial all spaces. Fill in aIl appropriate blanks, <br /> check all appropriate boxes . <br /> , <br /> Initi <br /> � 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: <br /> ' A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities : 1 ) gal . 2 ) gal . 3 ) gal. <br /> B. Pump Station (if required) <br /> Pump make & model (attach pump curve & <br /> literature) ; system design requires gpm at feet <br /> of head. High water alarm make & model <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 /U <br /> Depth of rock below pipe " Rock bed dimensions��' x(� ' <br /> Drop Boxes Sand bed dimensionsl�lx�? <br /> Distribution Box Pressure Dist. Pipe Diam.��_ <br /> Manif old Pipe Diam. �" <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> trucked in <br /> #**�**##*�*************#�*****#�***�***�**�****************�**�******#***** <br /> The 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 /> of Minnesota, and certifies that all statements made on this application <br /> are comp i ete, true and c rre ct. <br /> Signature of Applicant: � �l�'V `-/� � Zf <br /> Date: <br /> ;�SPCA Certification No. : � -, � <br />