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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 �Y'• ti <br /> Permit Type a Fees (check one) <br /> N Construction, Full System $75.00. . . . . . . . . . . . . . . . . . <br /> eplace 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 PAYMENT WITH THIS APPLICATION <br /> NOTE: pp licant must initial all spaces. Fill in all appropriate blanks, <br /> ah k all appropriate boxes. <br /> i <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 foil ing: <br /> A. Tanks: Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) OVil gal. 2) IeWgal. 3 ) gal. <br /> B. Pump Station (if r ui d) <br /> Pump make & mode ,v � �� (attach pumv curve & <br /> literature) ; system design requires m at eet <br /> of head. High water alarm make & mo el <br /> Outside electrical work to be completed y 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 /6? x,.�' <br /> Drop Boxes Sand bed dimensions 0'x_NT' <br /> Distribution Box Pressure Dist. Pipe Diam. " <br /> Manifold Pipe Diam. " <br /> D. Final Cover/Topsoil to be: bo wed 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 t t all statements made on this application <br /> are complete, true and corre <br /> Signature of Applicant• Date: <br /> MPCA Certification No. : 4 <br />