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IP 4 <br /> SEPTIC 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 /> *************************************************************************** <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: 2 Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) 2c ,gal. 2 ) 10c6gal. 3 ) gal. <br /> B. Pump Station (if required) <br /> Pump make & model 11) l Yf (attach pump curve & <br /> literature) ; system design requires gpm at 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. <br /> C. T eatment System: <br /> r)�1 : Trenches: s.f. Mound 11-.04lszSade.-t.� <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 /> *************************************************************************** <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 /> Signature of Applicant - Date: ://5-)4 'Z <br /> MPCA Certification No. : <br />