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. <br /> � <br /> I\TOTE: 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 desi�n including the City of Orono Septic <br /> System Approval Cover Sheet. <br /> 2. I will be installinJ the followin�: <br /> A. Tanks: ;:�_5�� 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 of head. <br /> Hi�h water alarm make& model . Outside <br /> electrical work to be completed by installer electrician other. <br /> C. Treatment System: <br /> ��\ �"`'; _;�_Trenches: �� '�� s.f. Mound <br /> -'rC' Depth of rock below pipe " Rock bed dimensions ' x ' <br /> >�.� � :� � Drop Boxes Sand bed d'unensions ' x ' <br /> � '� Distribution Box Pressure Dist. Pipe Diam. °' <br /> Manifold Pipe Diam. " <br /> D. Final Cover/Topsoil to be: bonowed from site <br /> (show location on site plan) <br /> trucked in <br /> The undersijned hereby applies to the City of Orono for issuance of a septic system installation permit, <br /> a�rees to do all �vork in strict accordance with ordinances of the City and the re�ulations of the State <br /> of�Iinnesota,and certifies that all statements made on thi�application are complete,true and correct. <br /> �_. <br /> Si�natureofApplican�-�- ._ ,���_ _ Date: �� � ��� <br /> MPCA License No. %.;2('� <br /> ----------------------------------------------------------------------------------------------------------------------�- <br /> StaffRevie��-: Approval � Denial <br /> Res•ie�ver: ��I�tJC ��2�,-._in--, Date: �`�7 — � � <br /> Reason for Denial: <br />