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>EPTIC 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 /> t************************************************************************** <br /> :40TE: Applicant must initial all spaces. Fill in all appropriate blanks, <br /> check all appropriate boxes. <br /> Initial <br /> AV/0 1. I have received a copy of the system design including the <br /> City of Orono Septic System Approval Cover Sheet. <br /> )5VA 2. I will be).nstalling the following: <br /> A. Tanks: ti Precast Concrete Other Manufacturer �j-ecas74-Sy ht <br /> Tank Capacities : 1) ,OQO gal. 2 ) )6n21 gal. 3 ) /000 gal. <br /> B. Pump Station (if required) <br /> Pump make & model AAAy lorS ,A4 40 (attach pump curve & <br /> literature) ; system design requires 40 gpm at 23 feet <br /> of head. High water alarm make & model ,5TH„P„ /0/h` . . <br /> Ou,tside electrical work to be completed by installer <br /> Velectrician _other Inside electrical work <br /> must be completed by electrician. <br /> C. Treatment System: <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe ” Rock bed dimensions /0"x4",3-' <br /> Drop Boxes - Sand bed dimensions 'x is/l9/ 4 c <br /> Distribution Box Pressure Dist. Pipe Diam. a" s 4 <br /> Manifold Pipe Diam. <br /> D. Final Cover/Topsoil to be: i borrowed from site fr"x aR epptekt- <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: t 44/IoN1 Date: a/03 <br /> APCA Certification No. : J002.g <br />