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SEPTIC SYSTEM PERMIT APPLICATON - PAGE 2 <br /> Permit Type & Fees (check one) <br /> New Construction, Full System $100.00 <br /> pc 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 /> check all appropriate boxes. <br /> I gr:sit <br /> pie! <br /> . _i. 1. I have received a copy of the system design including the <br /> wow, City of Orono Septic System Approval Cover Sheet. <br /> 4.140k <br /> 02. I will be installing the following: <br /> A. Tanks: I Precast Concrete Other Manufacturer <br /> Tank Capacities: 1) /NV.) gal. 2 ) LAW gal. 3 ) 1ekd gal. <br /> B. Pump Station (if re wired) <br /> Pump make & modelle, /J 3 P F (attach pump curve & <br /> literature); system design requires 7/ gpm at .IBJ feet <br /> of head. High water alarm make & model,4 4 Sci i.47;2 ;C, . <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. X Mound <br /> Depth of rock below pipe if Rock bed dimensions 42,:x20,/ ' <br /> Drop Boxes Sand bed dimensions ‘a'x <br /> Distribution Box Pressure Dist. PipeDram. /)- " <br /> Manifold Pipe Diam. " — <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> X 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 correc <br /> 4404 OP <br /> Signature of Applicant: .. Date: 6-2A/- 2. <br /> MPCA Certification No. : . /.4r. 410 <br />