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,' <br /> t <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> ,---� <br /> � (� l. I have received a copy of the system design including the City of Orono <br /> Septic System Approval Cover Sheet. <br /> / <br /> G C,� 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 of head. <br /> High water alarm make & model Outside <br /> electrical work to be completed by installer electrician <br /> other . Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System:f���� <br /> ✓ Trenches: .� �`L 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. " <br /> Maniford 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 <br /> permit, agrees to do all work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minnesota, and certifies that all statements made on this application <br /> are complete, true and correct. <br /> SignatureofApplicant: ' ' ,�� �`-'�'��'����`� Date: � %7� y ����' <br /> MPCA Certification No.: 5 i <br /> Staff Review: A�oval Denial <br /> � ; <br /> Reviewer: �� �Z� Date: ��� I`�' �U <br /> Reason for Denial: <br />