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� <br /> � <br /> >EPTIC SYSTEM PERMIT APPI�ICATON - 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 surchar�e added to above permit fees . <br /> SEE FEE SCHEDULE FOR NON-RESIDENTIAL PERMIT FEES <br /> DO NOT MAIL PAYi�NT WITH THIS APPLICATION � <br /> kir�**irir*f�f�*ic****tir#**tir******���*t**�**t�*�r****�#******�**�#****�t�f**�fir <br /> :�OTE: Applicant must initial. all 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 followingz <br /> A. Tanks: Precast Concrete Other Manufacturer <br /> ' Tank Capacities: 1 1. 2��ga1. 3 I. <br /> B. Pump Station (if required) <br /> Pump make & model ��/��, �' � (attach pum curve & <br /> literature) ; system design re ires �O gpm at �,_ feet <br /> of head. High water alarm make & model � <br /> Outside electrical work to be completed by _install.er <br /> e3.ectrician other Inside electrical work <br /> must be completed by electrician. <br /> C. Treatm t Syste <br /> Tr�n e s: s.f. Mound <br /> Depth of r below pipe " Rock bed dimensions �'x�� <br /> ro ox �___ _..._ - Sand bed dimensions�,�'x� <br /> Distribution Box Pressure Dist. Pipe Diam. !G, " <br /> Manifold Pipe Diam. �" <br /> D. Final Cover/Topsoil to be: borrowed from site <br /> (show location on site plan) <br /> � trucked in <br /> t**��*#*#�**ttt�***tt**�***t****#*tt**#*t*�***t��**t*t�t*�t*�**t*�**���*�*t <br /> mhe undersigned hereby applies to the City of Orono f or 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 app lication <br /> are complete, true and correct. " <br /> Signature of Applicant: Date: l� �/��� <br /> _4PCA Certification No. : � � � ' ' <br />