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,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 /> OTE: Applicant 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 lhstalling the following: <br /> A. Tanks: I Precast Concrete Other Manufacturer `` <br /> Tank Capacities : 1) / r� gal. 2 ) � c gal. 3 )A�)gal. <br /> B. Pump Station (if required) <br /> Pump make & model / I ell /Z //,�-///- (attach pump curve & <br /> literature) ; system design requires Lam. gpm at ;?- I/ feet <br /> of h d. High water alarm make & model �`� �� r—t <br /> O side electrical work to be completed by `installer <br /> _electrician _other Inside electrical work <br /> must be completed by electrician. <br /> C. Treatment System: <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe Rock bed dimensions /("'X $' <br /> Drop Boxes Sand bed dimensions �K- 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 /> 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 application <br /> are complete, true and corn ct. <br /> Signature of Applicant: �.� Date: <br /> _dPCA Certification No. : <br />