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1 . <br /> . <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks and check aIl appropriate <br /> boxes. <br /> � � 1. I have received a copy of the system design includin� the City of Orono Septic <br /> System Approval Cover Sheet. <br /> �� 2. I will be installinQ followin�: <br /> �� <br /> A. Tanks: r/ Precast Concrete Other Manufacturer ���W�� <br /> �r,s�.� �«,�h-� , <br /> Tank Capacities: 1) ,��-v jal. 2) �vzyo gal -��� )��p D �al ���f <br /> B. Pump Station (if required <br /> Pump make& model �y-e��✓ ����`��' (attach pump curve& <br /> literature); system desijn requires z`7 gpm at �S � feet of head. <br /> High water alarin make &model [�.�.-c(�,rv�-� . Outside <br /> electrical work to be completed by installer electrician other. <br /> C. Treatment System: <br /> Trenches: s.f. �ound <br /> Depth of rock below pipe " Rock bed dimensions rv ' x �3�' <br /> Drop Boxes Sand bed dimensions�' x L' <br /> Distribution Box Pressure Dist. Pipe Diam� %L " <br /> Manifold Pipe Diam. Z- " <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> . �show location on site plan) <br /> v trucked in <br /> The undersigned hereby applies to the City of Orono for issuance of a septic system installation permit, <br /> agrees to do all work in strict accordance with ordinances of the City and the regulations of the State <br /> of Niinnesota,and certifi 11 ents � ade on this application are complete,true and correct. <br /> SignatureofApplicant \ 'eS Date: �j ��— � � <br /> MPCA License No. � �� <br /> o � I��Qc� �� s�- �� piA <<� W l�� ��eS <br /> . <br /> StaffRev�e�v: Approva� � I)enial <br /> w <br /> � �ilte: ( '� �,7` � �� <br /> I�eviewer: �_ <br /> �easo� fo, �enial: <br />