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� ' t <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, check all appropriate <br /> boxes. <br /> � 1. I have received a copy of the system design including the City of Orono <br /> Septic System Approval Cover Sheet. <br /> ( 2. I will be installing the following: X ��er Manufacturer <br /> A. Tanks: Precast Concrete _ <br /> Tank Capacities: 1) -P o gal. 2) a�� gal. 3) /z 7� gal. <br /> B. Pump Station (if required) a�ch um curve & <br /> Pump make & model l<,J ��7 ll ,�- ��1.I� ( P P <br /> literature); system design requires gpm at feet of head. <br /> High water alarm make & model . Outside <br /> elecuical work to be completed by installer electrician <br /> other . Inside electrical work must be completed by <br /> electrician. <br /> C. Treatment System: <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe <br /> " Rock bed dimensions j� 'x 77, ' <br /> Drop Boxes Sand bed dimensions �,/� 'x 7��' <br /> Distribution Box Pressure Dist. Pipe Diam.�_ <br /> �� <br /> Maniford Pipe Diam.z.- '� <br /> D. Final Cover/Topsoil to be: borrowed 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 <br /> permit, agrees to do all work in strict accordance with the ordinances of the City and the <br /> regulations of the State of Minnesota, and certifies that all statements made on this application <br /> are complete, true and correct. <br /> � � <br /> SignatureofApplicant: �/ /J. 1� ' � Date:� � �— -- <br /> MPCA Certification No.: <br /> Staff Review: Approval Denial <br /> Reviewer: Date: <br /> Reason for Denial: <br />