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4� t <br /> >EPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit Type & Fees (check one) <br /> � New Construction, Full System $100. 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 MAIL PAYMENT WITH THIS APPLICATION <br /> k***#*irir*ltff**f***ie********#ir�le***#*****ir***f****!*****ir#*ir***t***ir*#f**#� <br /> :�OTE: Applicant must initia7. all spaces. Fill in all appropriate blanks, <br /> check all 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 will be installing the following: <br /> A. Tanks: �Precast Concrete Other Manufacturer <br /> Tank Capacities : 1) /�s� gal. 2 ) f ?> gal. 3 ) �� s ��gal. <br /> B. Pump Station (if required) <br /> Pump make & model /� _�� C� (attach pump curve & <br /> literature) ; system design equires �gpm a /�' feet <br /> of head. High water alarm make & model <br /> Outside electrical work to be completed by _installer <br /> electrician �other Inside e].ectrical work <br /> must be complete by electrician. <br /> C. Treatment System: <br /> Trenches: s.f. �-- Mound � � <br /> Depth of rock below pipe " Rock bed dimensions /�'x �Y ' <br /> Drop Boxes - Sand bed dimensions �'x ��' <br /> Distribution Box Pressure Dist. Pipe Diam. /v�" <br /> ManifoI.d Pipe Diam. � " <br /> D. Final Cover/Topsoil to be: � borrowed from site <br /> (show location on site plan) <br /> trucked in <br /> #******t��*#ttt�**�*�*�******t�*�*****�***�***t*:�*�*****�t***��****�#**��* <br /> The undersigned hereby applies to the City of Orono for issuance of a <br /> septic system installation permit, agrees to do al 1 work in strict <br /> accordance with the ordinances of the City and the regulations of the State <br /> of Minnesota, and certifies that all statements made on this application <br /> are comp lete, true and correct. � <br /> Signature of Applicant: Date: ��� <br /> .dPCA Certification No. : � ' <br />