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' . � <br /> 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 desi�n includin� the City of Orono Septic <br /> System Approval Cover Sheet. <br /> �/ 2. I will be installin� the followin�: <br /> A. Tanks: � Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) �6 O �al. 2) �al 3) jal <br /> B. Pump Station (if required) <br /> Pump make & model (attach pump curve Rc <br /> literature); system desi�n requires jpm at feet of head. <br /> High water alarm make & model . Outside <br /> electrical work to be completed by installer electrician other. <br /> C. Treatment System: <br /> Trenches: s.£ l�Iound <br /> Depth of rock below pipe " Rock bed dimensions ' x ' <br /> Drop Boxes Sand bed dimensions ' x ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Manifold Pipe Diam. " <br /> D. Final Cover/Topsoil to be: borro�ved from site <br /> (show location on site plan) <br /> trucked in <br /> The undersi�ned 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 re�ulations of the State <br /> of IVlinnesota,and certifies t all statements made on this application are complete,true and correct. <br /> � <br /> SignatureofApplicant ��. � Date: 1 / �/ 6 5 <br /> iVfl'CA�,icense No. � � � � <br /> ---�-------•-------------------------------------------------------------------------------------------------------------- <br /> n . <br /> 5��af�'�e��e�ti�: �p�rovaq `; �er�o�a� <br /> �pvies���A.a ; � � A)�ate; � ` - /—d J <br /> �e�son �t��� �enaa:: <br />