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. <br /> 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 ins lling the following: <br /> A. Tanks: Precast Concrete Other nufacturer <br /> Tank Capacit s: 1) gal. 2) ga 3) gal <br /> B. Pump Station (if r uired) <br /> Pump make& mode (attach pump curve& <br /> literature); system des n requires gpm at feet of head. <br /> High water alarm make model . Outside <br /> electrical work to be comp ted by installer electrician other. <br /> C. Treatment System: <br /> Trenches: s.f Mound <br /> Depth of rock below pipe " Rock bed dimensions ' x ' <br /> Drop Boxes Sand bed dimensions ' x ' <br /> Distribution B ressure Dist. Pipe Diam. " <br /> nifold Pipe Diam. " <br /> D. Final Cover/To soil to be: bor wed 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 /> a�rees 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 made on this application are complete,true and correct. <br /> Signature of Applican�1���/-� Date:�� —� �v �� <br /> NIl'CA License No. f� � � <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval Denial <br /> Reviewer: �� ,/�� i�zi�J1 Date: �����G.� <br /> iZeason for I)enia9: <br />