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1111, <br /> ,EPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit Type & Fees (check one) <br /> • <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 /> t************************************************************************** <br /> :40TE: Applicant must initial all spaces. Fill in all appropriate blanks, <br /> check all appropriate boxes. <br /> Initial <br /> I have received a copy of the system design including the <br /> TO <br /> 1. <br /> City of Orono Septic System Approval Cover Sheet. <br /> 2. I will be installing the following: <br /> A. Tanks: x Precast Concrete Other Manufacturer <br /> Tank Capacities : 1) j n o gal. 2 ) gal. 3 ) gal. <br /> B. Pump Station (if reuired) <br /> Pump make & model /fvc , f2/1g� I. (attach pump curve & <br /> literature); system design requires ?z gpm at 2. ? feet <br /> of head. High water alarm make & model" <br /> Outside electrical work to be completed by _installer <br /> _electrician 4other . Inside electrical work <br /> must be completed by electrician. <br /> C. Treatment System: <br /> Trenches: s.f. k, Mound <br /> Depth of rock below pipe Rock bed dimensions la 'x 5-5-' <br /> Drop Boxes - Sand bed dimensions a'x 2 P <br /> Distribution Box Pressure Dist. Pipe Diam irk <br /> Manifold Pipe Diam. 2 It <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: AL) -_ f <br /> APCA Certification No. : - <br />