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SEPTIC SYSTEM PERMIT APPLIGATON - PAGE 2 � . . <br /> Permit Type � Fees (check one) <br /> New Construction, Full System $75.00. . . . . . . . . . . . . . . . . . <br /> _Replace Existing System (1 or more new tanks & drainfield) $SO. QO. . . . <br /> Partial Replacement (reglace just tanks or just drainfield) $30.00. . <br /> $0.50 State surcharge added to above �ermit fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYMENT WITH THIS APPLICATION <br /> ***********t*t************************�****�***********:*�*********:**�*t:* <br /> . NOTE: ApF licant must initial all spaces. Fill in al 1 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 foll ing: <br /> - A. Tanks: �Precast Concrete �ther Manufacturer <br /> " Tank Capacities: 1) � v=ga1• 2� 1Ueo .gal. 3) ���gal. <br /> g. Pump Station (if required) <br /> Pump make & model 5 P� r0 � � • (attach pump curve & <br /> literature) ; system design requires 3q • gFin at �� feet <br /> of head. High water alarm make & model • <br /> �Out 'de electrical work to be completins bde electrical work <br /> ectrician_ - _other _ • <br /> _mu�t-be- "completed by electrician. <br /> C. Treatment System: Mound <br /> Trenches:� s.f. <br /> Depth of rock below pipe �� Rock bed dimensions _'x ' <br /> c� Drop Boxes Sand bed dimensions 'x ' n <br /> _� Distribution Box Pressure Dist. Pipe Diam. <br /> �Ma ifold Pipe Diam. " <br /> owed from site . <br /> D. Final Cover/Topsoil to be: borr <br /> (show location on site plan <br /> trucked in <br /> *:�******�****#*:**�**�**�**************t************:*****:*�*******t***:* <br /> The undersigned hereby applies 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 certifies that all statements made on this app lication <br /> are comp lete, true and correct. <br /> Signature of Applicant: � Date: / <br /> MPCA Certification No. : � <br /> �Su� <br /> � � � <br /> �� -� 1 <br /> ID <br /> , ��( <br />