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a <br /> . -. <br /> SRPTIC SYSTEM PERlsIT APPLICATON - PAG$ 2 <br /> i <br /> Permit Type & Fees (check one) <br /> New Construction, Full System $100. 00 . . . . . . . . . . . . . . <br />�_ Repair or Replace Existing System $50.00. . . . . . . . . . . . . <br /> $0.50 State surcharge added to above permit fees <br /> SEE FEE SCHEDt�LE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYMBNT WITS THIS APPLICATION <br /> ****��*****�*�*#**�**��:******�*****���*��*********����*:******�*�******�** <br /> NOT$: Applicant must initial all spaces. Fill in al 1 appropriate hlanks, <br /> check all appropriate boxes. <br /> Initial <br /> 1. I have received a copy of the system design including the <br /> City of Orono Septic System Approval Cover Sheet. <br /> 2. I will b installing the following: <br /> A. Tanks: � Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) l�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 <br /> of head. High water alarm make & model . <br /> Outside electrical work to be completed by _installer <br /> electrician other . Inside electrical work <br /> must be completed by electrician. <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 /> #�*�***:*�:*****�*::*:���:�*:*�****�*****�***::***tt*��***:*#:****���*�***� <br /> The undersigned hereby applies to the City of Orono for issuance of a <br /> septic system installation permit, agrees to do all work in strict <br /> accor�ance with the ordinances of the City and the regulations of the State <br /> of Minnesota, and certifies that all statements made on this application <br /> are comp lete, true and correct. <br /> Signature of Applicant: Date: � ZS -- �//�'� <br /> MPCA Certification No. : . <br />