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S$PTIC SYSTEM PERMIT APPLICATON - PAGE 2 � • <br /> Permit Type � Fees (check one) - -- <br /> �New Construction, Full System $75.00. . . . . . . . . . . . . . . . . . <br /> ..�Re lace Existing System (1 or more new tanks & drainfield) $50.00. . . <br /> �tial Replacement (replace just tanks or just drainfield) $30.00. . . <br /> $0.50 State surcharge added to above permit fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYMENT WITH THIS APPLICATION <br /> ***�*****************�**********�********************s****��*********�***** <br /> NOT$: Applicant must initial all spaces. Fill in al 1 appropriate blanks, <br /> check all appropriate boxes. <br /> In' 1 <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 be installing the following: <br /> A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) 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: �SQ 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 /> �******�**:�r*:t�*****:��****:**�***:**:***:*:**:***�*******��*�*�**�**�*:** <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 /> accordance with the ordinances of the City and the regulations of the State <br /> of Minnesota, and certifies tha all statements made on this application <br /> are complete, true and correc <br /> Signature of Applican • Date: �a'� ^ /l <br /> MPCA Certification No. : �� <br />