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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit Type a Fees (check one) <br /> New Construction, Full System $75.00. . . . . . . . . <br /> Replace Existing System (1 or more new tanks & drainfield 50.00 <br /> D) . <br /> Partial Replacement (replace just tanks or just drainfiel ) .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 /> NOTE: 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 installing the following: <br /> A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) zo) gal. 2)/1gal. gal. <br /> B. Pump Station (if required) <br /> Pump make & model, tL J(attach pump curve & <br /> literature) ; system desig qu <br /> reires ppm at J_ feet <br /> of head. High water alarm make & model 4 - <br /> Outside electrical work to be completedby installer <br /> ,electrician other Inside electrical work <br /> must be completed by electrician. <br /> C. Treatment System: <br /> Trenches: sof. Mound <br /> Depth of rock below pipe R ck bed dimensionsig 'xa�j_`' <br /> Drop Boxes Sand bed dimensions 'N��' <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 Ci y 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 correct. <br /> Signature of Applicant. <br /> �-� Date: �,� �' C <br /> MPCA Certification No. : <br />