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-.�. � . <br /> S$PTIC SYSTffiK P$RMIT APPLICATON - PAGE 2 <br /> Permit Type � Fees (check one) <br /> New Construction, Full System $100.00 . . . . . . . . . . . . . . <br /> L-- Repair or Replace Existing System $50.00. . . . . . . . . . . . . <br /> $0.50 State surcharge added to above permit fees <br /> . SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYMENT WITS THIS APPLICATION <br /> **�**�***��*����******����**��***�*�**�**��***��*�*****����*�:*�*****�*�*** <br /> NOT$: Applicant must initial al 1 spaces. Fill in all appropriate blanks, <br /> check all appropriate boxes. <br /> Initial <br /> 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 /> � Tank Capacities: 1) gal. 2) gal. 3 ) gal. <br /> G�� <br /> � B. Pump Station (if required) <br /> �/�_ o ump make & model (attach pump curve & <br /> rr,� l.,��1 V�I'iterature), system design requires gpm at feet <br /> o�r�' of head. High water alarm make & model <br /> �rp���� 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 � " Rock bed dimensions 'x ' <br /> Drop Boxes Sand bed dimensions 'x ' <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 /> 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: s+�.�—y� <br /> MPCA Certification No. : ��� � <br />