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f � <br /> NOTE: �Applicant rriusc initial alI spaces. Fill in alI appropriate blanks, check all a ro riat <br /> boxes. . pp p e <br /> r.i�,', . : <br /> � �` 1. I have received a copy of the system desiJn includinQ <br /> , � , Septic System Approval Cover Shee[. � �e Ciry of Orono <br /> . � I . <br /> �. � �'�,� .2. I �vill be�installin; thz following: � . . . <br /> A. Tanks: ' Precast Concrete Ocher Manufacturer <br /> Tank Capacities: I)��L�� QaI. � <br /> . � 2)--._ �al. �) gal.' <br /> �-�` `.�� � , <br /> - B• Pump Station (if required) <br /> Pump make & model . (attach pump curve & <br /> literacure); system desi;n requires Q <br /> High Svater aIarm make & model oPm at feet of head. <br /> � ' electrical work to be completed by installer • Outside <br /> other eleccrician <br /> . Inside electrical work must be completed by <br /> electrician. . <br /> ' C. Treatment System: <br /> � Trenches: s.f. Mound <br /> Dep[h of rock below pipe " Rock bed dimensions �'X � <br /> � Drop Boxes � Sand bed di.mensions 'x � - <br /> Distribution Box � Pressure Disc. Pipe Diam. � '� <br /> � .Maniford Pipe Diam. ' � " <br /> D. Final Cover/Topsoil to be: borrotved from site <br /> (show location on site pla�)- � <br /> trucked in <br /> The undersi�ned hereby applies to the City of Orono for issuance of a septic system installation <br /> permit, a�rees to do all work in strict accordance wich the ordinances of the City and the <br /> . regulations of ihe State o lbi�,�inesota, and cenifie thac aIl statements made on this application <br /> are complete, true and c�rrect'. �' <br /> I � ,� �, , <br /> Si�natureofApplicanc: ,� _ � �(�______i_. <br /> — ��. c Date: �1--��-���'� <br /> MPCA Certification No.: . � - � <br /> Staff Review: �.� ' rov be�� . . <br /> ' � � � � . <br /> ReFiesver: i .(���/ ' . � <br /> � Date: 11-3���-`�� • <br /> Reason for Denial: � <br />