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_ . . . . _ __. .. _ .. . .._ _ �.� <br /> SEPTIC SYSTEM PBRMIT APPLICATON - 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) $50.00. . . <br /> Partial Replacement (replace just tanks or just drainfield) $30. 00. . . <br /> $0.50 State surcharge added to above permit fees <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYr�NT WITH THIS APPLICATION <br /> ****�****#�#*�*************�*�*********�********�*******#**t*�***�****�**** <br /> NOT$: App licant must initial 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 ) ��-��. gal. 2 ) �'<-'�' gal. 3 ) �� �;;• gal. <br /> B. Pump Station (if required) <br /> Pump make & model �� (attach pump curve & <br /> literature) ; system design requires � �� gpm a��= feet <br /> of head. High water alarm make & model <br /> Outside electrical work to be completed by _installer <br /> L`�electrician other Inside electrical work <br /> must be completed by electrician. • <br /> C. Treatment Syst m- G, <br /> Trenches: % • � s.f. Mound <br /> Depth of rock below pipe �" Rock bed dimensions 'x ' <br /> � Drop Boxes Sand bed dimensions 'x ' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Manifold Pipe Diam. " <br /> D. Final Cover/Topsoil to be: borrowed from site <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 al 1 statements made on this app lication <br /> are complete,. true and correct. <br /> " ,, C_ /' ) �-_\` . , � � � C' � , <br /> Signature of Applicant���� ._ /�°� l ���,_� , . � Date: '� � / , <br /> % � � <br /> MPCA Certification No. : � �' �' -% �� � <br /> i <br /> I <br /> � <br /> t <br /> �: <br />