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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 .. <br /> Permit Type & Fees (check one) <br /> New Construction, Full System $75.00 <br /> Replace Existing System (1 or more pew 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 /> *************************************************************************** <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br /> check all appropriate boxes. <br /> Initial <br /> 04 Z 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: .3 Precast Concrete --Other Manufacturer fO/'-eCas( _5:79s7:- <br /> Tank Capacities: 1) /0" gal. 2 ) la'd gal. 3 ) -gal. <br /> B. Pump Station (if required) <br /> Pump make & model `S /v.-2-5- (attach pump curve & <br /> literature) ; system design requires 3( gpm at ACO, feet <br /> of head. High water alarm make & model <br /> Outside electrical work to be completed by installer <br /> electrician other . Inside electrical work <br /> must be completed by electrician. Ircr— <br /> C. Treatment System: <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe " Rock bed dimensions O '_ <br /> Drop Boxes Sand bed dimensio - 'x . 7'' <br /> Distribution Box Pressure Dist. Pip= Diam. - " <br /> Manifold Pipe Diam. ' ' <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> rucked in <br /> *************************************************************************** <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 correct. <br /> Lk) <br /> Signature of A licantG/�"(a? _-'�-�A''-' Date <br /> g pp <br /> : 6 - /r- 7/ <br /> MPCA Certification No. : 765 (/ <br /> t <br />