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. <br /> t <br /> ;EPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit Type � Fees (check one) <br /> ✓ New Construction, Full System $I00 . 00 . . . . . . . . . . . . . . <br /> Repair or Replace Existing System $50 . 00 . . . . . . . . . . . . . <br /> 0 . 50 State surcharge added to above permit fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAII� PAYMENT WITH THIS APPLICATION <br /> �*ft****�r*tt*�*f**t�#t***��*�t�**:##*�***#*********t*#**�*�******�**���**f* <br /> �OTE: Applicant must initial all spaces. Fill in aIl appropriate blanks, <br /> check al1 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 wi11 be installing the following: (� <br /> A. Tanks: �Precast Concrete � Other Manufacturer �JCL�vJ�^ <br /> Tank Capacities : I.) �Q�gal. 2 ) gal. 3 ) gal. <br /> B. Pump Station (if required) <br /> Pump make & model (attach pump curve & <br /> literature) ; syste.*n design requires gpm at f eet <br /> of head. High water alarm make & model � <br /> Outside electri.cal work to be completed by _installer <br /> electrician other Inside electrical work <br /> must be completed by electrician. <br /> C. Treatment System: <br /> � Trenches:� s.f . Mound <br /> �De th of rock below pipe �� " Rock bed dimensions 'x ' <br /> Drop Boxes - Sand bed dimensions 'x ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Manif oid Pipe Diam. " <br /> D. Final Cover/Topsoil to be: ✓ borrowed from site <br /> (show location on site pl.an) <br /> trucked in <br /> **�#*#fft�*�**�****t********�****tff**#*�****#****t:**f**�tt*********t***t* <br /> mhe undersigned hereby applies to the City of Orono for issuance of a <br /> septic system instailation permit, agrees to do all work in strict <br /> accordance with the ordinances of the City and the regulations of the State <br /> �f Minnesota, and certifies that all statements made on this application <br /> are comp lete, true and c rrect. � <br /> , <br /> �ignature of Applicant� ` Date: ��,•�� �� <br /> _dPCA Certification No. : 1 �q� � � <br />