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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 includinj the City of Orono Septic <br /> System Approval Cover Sheet. <br /> 2. I will be installin?the followin�: <br /> A. Tanks: <br /> � Precast Concrete Other Manufacturer�����'""� <br /> Tank Capacities: 1) /�/�� gal. 2) /C�C�O gal 3) gal <br /> B. Pump Station (if requir d)�/ <br /> Pump make& model�� /' �11�. .�gx A �c�- (attach pump curve& <br /> literature); system desi?n requires�gpm at :z� feet of head. <br /> Hi�h water alarm make& model .��rj�� :/����or�-. . Outside <br /> electrical work to be completed by installer electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. �_ Mound � <br /> Depth of rock below pipe " Rock bed dimensions/U ' x ��'' <br /> Drop Boxes Sand bed dimensions�� ' x c5,�' <br /> Distribution Box Pressure Dist. Pipe Diam. Z " <br /> Manifold Pipe Diam. Z " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (sho�v location on site plan) <br /> � trucked in <br /> The undersijned hereby applies to the City of Orono for issuance of a septic system installation permit, <br /> a�rees to do all �vork in strict accordance with ordinances of the City and the regulations of the State <br /> of l�Iinnesota,and certifies that all statements made on this application are complete,true and correct. <br /> Signature of Applicant -e � Date: /Z `J��--�o�o <br /> NIPCA License No. 3/�� <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> � <br /> Staff Revie��•: Approval �l Denial <br /> ��A- � Q 1 <br /> Reviewer: ��w"\ ����'� Date• i—�� � I <br /> Reason for Denial: <br /> � -�d t 3 b U �r`-� v n��/ _ - , <br />