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SEPTIC SYSTEM PERMIT APPLICATON� PAGE 2 <br /> . <br /> Permit Type & Fees (check one) <br /> New Construction, Full System $75.00. . . . . . . . . . . . . . . . . . <br /> Replace Existing System (1 or more new tanks ' ' ' $50.00. . . <br /> �Partial Replacement (replace just tanks o just drainfield) $30.00. . . <br /> $0.50 State surcharge added to above permit fees <br /> SEE FEE SCHEDIILE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYMENT WITH THIS APpLICATION <br /> *************t*f*************#***********************�*******************�* <br /> NOTS: ApF licant must initial aIl 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) _9a1• 2� gal. 3) gal. <br /> B. Pump Station (if required) <br /> Pump make & model (attach pump curve & <br /> literature) ; system design requires gpm at _ feet <br /> of head. High water alarm make & model • <br /> Outside electrical work to be completed by installer <br /> electrician other . Inside electrical work <br /> must be completed by electrician. <br /> C. Treatment System: � �� � l� K S� <br /> Trenches: s.f. Mound /U t.�t� lv �c?'O <br /> Depth of rock b pipe " Rock bed dimensions _'x ' <br /> Drop Boxes Sand bed dimensions 'x � <br /> Distribution Box Pressure Dist. Pipe Diam. / /�. <br /> Manifold Pige Diam. �_" <br /> D. Final Cover/Topsoil to be: �r�show locationeon site plan <br /> � <br /> trucked in <br /> #******#******#***:*�****�*�:#:�:******�*�*:**t***:***:***�******��:�:***#* <br /> The undersigned hereby app lies to the City of Orono for issuance of a <br /> septic system installation permit, agrees to do all work in strict <br /> accordance with the ordinances of the City and the regulations of the State <br /> of Minnesota, and cer ifies that all statements made on this app lication <br /> are comp lete, true and orrect. <br /> Signature of Applicant: (�1/Y�� Date: �'�f—� <br /> MPCA Certification No. : � ��� <br />