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a <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 /> ch:ck all appropriate boxes.IlAkI. <br /> iR,lam >!.. 1. I have received a copy of the system design including the <br /> 1156.TA\ City of Orono Septic System Approval Cover Sheet. <br /> `al 2. I will be installing the following: <br /> NOW A. Tanks: . 3 Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) /Q/1'gal. 2 ) /4AV gal. 3 ) / 11 gal. <br /> B. Pump Station (if re uired) <br /> 0,4 <br /> Pump make & model(i/ 1 241;e57 (attach pump curve & <br /> literature) ; system design requires _7 gpm at /5' feet <br /> of head. High water alarm make & model <br /> Outside electrical work to be completed by ,installer <br /> _electrician _other . Inside elect'scal work <br /> must be completed by electrician. <br /> C. Treatme t System: <br /> Tren. hes: s.f. Mound <br /> Depth of oc. •elow pipe " ock bed dimensions/ xj,7 ' <br /> Drop =oxes Sand bed dimensionsx cia <br /> D . ri•ution Box Pressure Dist. Pipe Diam. /SI: <br /> Manifold Pipe Diam. " <br /> D. Final Cover/To,soil 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 t t all statements made on this application <br /> are complete, true and corre . <br /> 44 01, <br /> Signature of Applicant• ,i�i��� ,-0 Date: <br /> MPCA Certification No. : 14("e 4110r <br />