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;EPTIC SYS�EM PERMIT APPLICATON - PAGE 2 <br /> "� ; <br /> � Permit Type & Fees (check one) <br /> �New Construction, Full System $I00 . 00 . . . . . . . . . . . . . . <br /> Re�air 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 MAII� PAYMENT WITH �HIS APPLSCATION <br /> ►*�r***t*tttt**��**�r*t*t*****�f�*��rtt*****#****����r#**�r�r*:t***�**t*#*t�r*�r�ttf# <br /> �OTE: Applicant must initial al l snaces. Fil I in aIl appropriate blanks, <br /> check ail appropriate boxes . . <br /> Initial <br /> l. I have received a copy of the system design including the <br /> City of Orono Septic System Approval Cover Sheet. <br /> 2 . I wil.l be�snstalling the following: <br /> A. Tanks: �' Precast Concrete Other Manufacturer <br /> ,-, <br /> Tank Capacities : 1) C L`�Z% gal . 2 ) �L�Z���1 gal. 3 ) �yl��gal. <br /> B. Pump Station (if required) D <br /> Pump make & model 7 ���,�f/ (attach pump curve & <br /> I.iterature) ; system design�ires �gpm at � feet <br /> of head. High water alarm make & model ,� -r,.����-r ry� <br /> Ou,�side electrical work to be completed by installer <br /> ✓electrician other Inside el.ectrica� work <br /> must be completed by electrician. <br /> '� ��� j,�/�d ��P���� ,�� c� <br /> C. Treatment System: I' r'CS� � <br /> Trenches: s.f. � ��� <br /> Depth of rock below pipe l Z " Rock bed dimensions 'x ' <br /> Drop Boxes - Sand bed dimensions 'x ' <br /> Distribution Box Pressure Dist. Pipe Diam.� <br /> May�ifold Pipe Diam. Z/ " <br /> D. Final Cover/Topsoil to be: � borrowed from site <br /> (show Iocation on site plan) <br /> trucked in <br /> �t�t*�*�#�****tt***t*t*#******#**�****t****#***�t******���#***�***t**#**��t <br /> '='he undersigned hereby applies to the City of Orono for issuance of a <br /> septic system instailation permit, agrees to do alI 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 appl.ication <br /> are comp lete, true and correct. � <br /> � ; � <br /> � � �/- �_S <br /> Signature of Applicant: ��/"ZL��J �z�l'�'� Date: ��' � � <br />.dPCA Certification No. : � � <br />