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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 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 /> *************************************************************************** <br /> NOTE: Applicant must initial all spaces. Fill in all appropriate blanks, <br /> ch=ck all appropriate boxes. <br /> I , <br /> 117 1. I have received a copy of the system design including the <br /> WOOr City of Orono Septic System Approval Cover Sheet. <br /> 2. I will be installing the following: <br /> A. Tanks: 3 Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) /AV gal. 2)/(a$74/ gal. 3)/;2-:0 gal. <br /> B. Pump Station (if re uirej3)) �p <br /> Pump make & model b /d 3MI v '2 (attach pump curve & <br /> literature) ; system design requires 4ll gpm at eet <br /> of head. High water alarm make & model nctici ,'cI,7 • G . <br /> Outside electrical work to be complete by Installer <br /> electrician other . Inside electrical work <br /> must be completed by electrician. <br /> C. Treatment System: <br /> Trenches: s.f. Mound C C <br /> Depth of rock below pipe " Rock bed dimensions �'x ' <br /> Drop Boxes Sand bed dimensions ,'x7 ' <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 /> �ucked 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 tha all statements made on this application <br /> are complete, true and correc / <br /> , 440pr 00 <br /> /// '7/ <br /> Signature of Applicant- - ,,1 Date: 7 <br /> MPCA Certification No. : a <br />