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. <br /> Y <br /> 1 ' <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 installing the following: p <br /> A Tanks: �Precast Concrete Other Manufacturerf r�`4��- <br /> Tank Capacities: 1)/�� al. 2) �`Sa� - gal 3) �al <br /> ��E- /,.�rs�47`.�on� <br /> B. Pump Sta.tion(if required) n <br /> Pump make&model_ �aU��d� (atta.ch pump curve& <br /> literature); system design requires gpm at feet of head. <br /> High water alarm make&model ���Cm !' - . Outside <br /> electrical work to be completed by installer_�electrician other. <br /> C. Treatment System: �e��,r M�A�, SyS'f�� <br /> Trenches: s.f. _� �d-� <br /> Depth of rock below pipe " Rock bed dimensions Qo ' x�D_' <br /> Drop Boxes Sand bed dimensions ' x ' <br /> Distribution Box Pressure Dist. Pipe Diam. � �� " <br /> Manifold Pipe Diam. A�—" <br /> D. Final Cover/Topsoil to be: bonowed 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 State <br /> of Minnesota,and certifies that all statements made on this applica.tion aze complete,true and correct. <br /> SignatureofApplicant - Date: ���a — B 2 <br /> NII'CA License No. e��� <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Approval � Denial <br /> Reviewer: �^l�;� Date: v 1'�� �� <br /> Reason for DeniaL• <br />