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NOTE: 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 design including the City of Orono Septic <br /> System Approval Cover Sheet. <br /> 2. I will be installing the following: ,\ <br /> A. Tanks: �_Precast Concrete Other Manufacturer�A���� <br /> Tank Capacities: 1) �U� �al. 2)_�J gal 3) /d!� �al <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 other. <br /> C. Treatment System: <br /> Trenches: s.f. � Mound <br /> Depth of rock below pipe " Rock bed dimensions ►o ' x,�O' <br /> Drop Boxes Sand bed dimensions ' x <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Manifold 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 permit, <br /> ajrees to do all work in strict accordance with ordinances of the City and the regulations of the State <br /> of Nlinnesota,and certifies that all statements ade on this application are complete,true and correct. <br /> Signature of Applicant Date: l4-� � �� <br /> MPCA License No. � � � <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Revie�v: Approval Deniai <br /> Reviewer: ���,��t.�G _ D�te: � — � `7'd � <br /> �teason for Denial: <br />