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. <br /> . , 4 <br /> :EPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit Type � Fees (check one) <br /> New Construction, Full System $1�0. 00 . . . . . . . . . . . . . . <br /> � Repair or Replace Existing System $50. 00. . . . . . . . . . . . . <br /> �0.50 State surcharc�e added to above permit fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYMENT WITH THIS 1�PPLICATION <br /> E#**f�**t*#f�ir�ir#****#��*��*tie*�*�#t#*t**t****�r*ir**:t*ir**irir*���***�*ie*f���f� <br /> :�OTE: Applicant must initial all spaces. Fill in aIl appropriate bZanks, <br /> check al.l 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 Manufacture /�le- --���� <br /> Tank Capacities : 1) ���G gal. 2 ) !�� � gal. 3 ) gal- <br /> B. Pump Station (if re uir d) / <br /> Pump make & model�-� ���'�'� // (attach p curve & <br /> I.iterature) ; system desi requires �pm at �� feet <br /> of head. High water alarm make & model • � <br /> O tside electrical work to be completed by installer <br /> �electrician other Inside electrical work <br /> must be completed by electrician. <br /> * . <br /> C. Treatment System: <br /> Trenches: s.f. � Mound <br /> Depth of rock below pipe " Rock bed dimensions �U 'x -5 s' <br /> Drop Boxes - Sand bed dimensions �'x�' <br /> Distribution Box Pressure Dist. Pipe Diam�-f,�' <br /> Manifol.d Pipe Diam. Z` " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> trucked in <br /> *f�t**t��****�*�t**�*�f******t�#tt�t**���� * *ttttt**�t�t�#�**�t**�t:*�**tf <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 that all statements made on this application <br /> are comp lete, true and correct. � <br /> � D ��� _� ? . <br /> Signature of Applicant: �r�� Date: J <br /> _rlPCA Certification No. : �/ � <br /> � � �' /�e�� <br /> r� rs � 3�� , � � �! �. 1 <br /> � � � ,�c� v�wq i s mQ(r��,��o! <br /> �9►�'3 � e ra�h�t h.� a s !�� a � -��-o n. � � <br /> c� �`g,e sy��-. ,�r�,� �e ,���d . <br />