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�' ' . . <br /> • <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check all apprapria�e <br /> boxes. <br /> � i f ron Se tic <br /> 1. have received a copy of the system design mcluding the C ty o O o p <br /> System Approval Cover Sheet. <br /> 2. I will be installing the following: US� -�K��'�`'r"� 3��G"�`�ts <br /> A. Tanks: Precast Concrete _.._, n+hP*._.111�nufacturer <br /> _._ <br /> Tank Capacities:, '..`..—:�,a�:.�___�"-_�- 3) gal <br /> B. Pump Station(if required) <br /> Pump make&model�'���I� P� S � (atta.ch pump curve& <br /> literature); system design requires S 3 gpm at���feet of head. <br /> High water alarm make&model �ci-� �,�iw- . Outside <br /> electrical work to be completed by installer�/�electrician other. <br /> C. Treatment 5yst <br /> Tre es; s.f. Mound (z -zs '� <br /> Dep o ock below pipe " Rock bed dimensions/o ' x S v ' <br /> rop Boxes Sand bed dimensions�0 ' x�' <br /> Dis � x+N� Pressure Dist. Pipe Diam. 1'�Z " <br /> Manifold Pipe Diam. Z.- " <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 a11 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 application are complete,true and conect. <br /> Signature ofApplicant �S Date: g� � ��7 <br /> MPCA License Na � �T � <br /> Staff Review: Approval Denial <br /> Reviewer: ��,�,����� Date: �' 7�d� <br /> Reason for Denial: <br />