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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2.4 -• <br /> Permit Type & Fees (check one) <br />_ New Construction, Full System $75.00 <br /> Z 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 /> check all appropriate boxes. <br /> Initial <br /> c 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: Precast Concrete Other Manufacturer <br /> /Zo <br /> Tank Capacities: 1) gal. 2) /F gal. 3) /dam gal. <br /> B. Pump Station (if required) <br /> Pump make & model //D (attach pump curve & <br /> literature) ; system design require 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. Treatment System: <br /> Trenches: s.f. Mound <br /> Depth of rock below pipe " Ro k bed dimensions/ 'x3 ' <br /> Drop Boxes Sand bed dimensions w.L,xr <br /> Distribution Box Pressure Dist. Pipe Diam. - " <br /> Manifold Pipe Diam. " <br /> D. Final Cover/Topsoil to be: A 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 //1Ir ..----0,.�,— Date: /, "°" <br /> 6 <br /> MPCA Certification No. : gv3 <br />