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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 design includin� the City of Orono Septic <br /> System Approval Cover Sheet. <br /> �l�- 2. I will be installing the following: <br /> A. Tanks: �_Precast Concrete Other Manufacturer A�'.�� <br /> Tank Capacities: 1) ) �,c,c� gal. 2) vt�c� gal 3) � bpo gal <br /> B. Pump Station(if required) <br /> Pump make & model (�L,v�i��� t��o�-t� t-k (attach pump curve& <br /> literature); system design requires � �� gpm at /S' feet of head. <br /> Hijh water alarm make & model ���d . 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��' x �C� <br /> Drop Boxes Sand bed dimensions �/3' x `�'O' <br /> Distribution Box Pressure Dist. Pipe Diam. ) '� " <br /> Manifold Pipe Diam. � �� " <br /> D. Final Cover/Topsoil to be: borrocved 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 permit, <br /> a�rees to do all work in strict accordance with ordinances of the City and the regulations of the State <br /> of Nlinnesota,and certifies that all statements ade on �s application are complete,true and correct. <br /> SignatureofApplicant �1�� , Date: �—� —b�� <br /> MPCA License No.���2, <br /> -------------------------------------------------------------------------------------------------------------------------- <br /> Staff Review: Ap oval � Denial <br /> Reviewer: \ ��'�� Date: �b'� D C� <br /> Reason for Denial: <br />