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NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> laoxes. <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 insta.11ing the following: <br /> A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) gal. 2) gal 3) gal <br /> B. Pump Station(if�equired) <br /> Pump make& model (atta.ch pump curve& <br /> literature); system design requires gpm at feet of head. <br /> High water alann make&model . Outside <br /> electrical work to be completed by insta.11er 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 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 /> agrees to do all work in strict accordance with ordinances of the City and the regulations of the Sta.te <br /> of Minnesota,and certifies t t al sta.t ments made n this application are complete,true and conect. <br /> Signature of Applicant vV Date: ��' ��`�� <br /> MPCA License No. �L 4 7.5� <br /> ------------------------------------------------------------------------------------------------------------------------ <br /> Staff Review: Approval � Denial <br /> Reviewer: �al� ��\�51�1�Y� Date• �1 —t�^U� <br /> Reason for Denial: <br />