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_ r_� k <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all appropriate <br /> boxes. <br /> � l. 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 <br /> Tank Capacities: 1) �al. 2) al 3) �al <br /> � . ,. � . ../�t-M�a � P a n' ° <br /> B. Pump Sta.tion(if required) <br /> Pump make&model Q�r(� (attach pump curve& <br /> literature); system design requires gpm at feet of head. <br /> High water alarm make&model Aa P1'. . Outside <br /> electrical work to be completed by installer�electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. �C 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: 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 certifi s that all statements made on this application aze complete,true and conect. <br /> SignatureofApplicant Date: �r �g- � � <br /> MPCA License No. 2.r g <br /> Staff Review: Approval Denial <br /> �`r.or�.. y.2�-o� <br /> Reviewer: Date• <br /> Reason for Denial: <br />