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01.06'55 15:20 THP fjF npijrin 612-JVJ-Vif.? <br />CITY OF ORONO <br />(012) 473-7357 <br />2750 Kelley Parkway, p.o. Hot 66 <br />Crystal Bay. MN 55323 <br />SEPTIC S VSTEMINSTAIXERS <br />LICENSE .APPLICATION <br />All qucslicns must be answerec License fee. ’ -.J. Certificate of Insurance and evidence of MPC a <br />Cenification must be atLicJied. All appli';ation>' arc subject to a ten (10) day app.'-ovai period. <br />1. Bu.siness or trade name , JZnc ______________ <br />2. Business addrcs.s 1‘SL'!^ ______C^DU <br />(iirefij <br />3. Business pbonc^__O ^ 'P- .93 <br />tcicy) (/.p) <br />Residence phone i^l-Cyi.Lc'? <br />A.Narne of anpl'catu or company lepiescnfauvc^s) holding MPCA certification <br />H-I Xoc ■________________________ <br />5. Type of certification held: _Installer Ihimper Expiration date: <br />6. Have >ou ever held a Septic Systen, Installer license in Orono before?_I\) Q <br />Most recent year______________ <br />Ha\C you ever i;ad a license revoked? _When? ______________________ <br />Whctc? <br />8. Do you dj Municipal Sewer hook-ups^ '■'es No <br />9. Do you pump cut septic tanks? Yes . No <br />SLT5MITT.VLS REQUIRED: <br />CIT'i CF^ <br />FlivAi'^CE OFFICE <br />! * i -sV .Vi.Via AwVW W <br />* wni v.i cyt <br />^ iww rif »^ <br />‘xziElFT-TF^S fiO <br />nIOziiO CCOl fiOl lU <br />r. *» . * <br />%^V* • Vr,-) ; <br />W* V • V <br />nivx.' a- <br />-e::. I- <br />2. <br />3. <br />$50.0<7 License application fee. <br />S2,000.09 license and permit bond naming City of Orono as obligee. The State Plumbers <br />Bond will not be -accepted. <br />$50'100-300,000 minimum Ceiiificate of Insurance. <br />Copy of current MPCA Ccnificatc. <br />LICENSES WELL NUT BE PROCESSED UNTIL .\LL mvMS ARE SUBMITTED <br />List persons either than applic.ant who are authorized by y(?u to aoidv f'nr nertnit-s under your licetisc <br />The undersigned h.ereby makes appiicatirm to the City of Orono, Minnesota, for a liccn.se to lastaH <br />and repair reptic systems, and/or pump out septic tanks, su^eci to the laws of the State of Mimic ota <br />anrf fhr» C^rAtnAnC^^ of ihf (^IfV nf Oinrin __Xand the Ordinances of the City of Oiono. <br />Date J ^Aoclicant'sSiemfure <br />CI TY Staff recommendation: Approval Denial Date <br />Reason for denial:U.5K <br />ONLY City Couticil Act;v''n: Date_Ariproved Denied