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CITY OF ORONO <br />(612) 473-7357 <br />2750 Kelley Parkway, P.O. Box oo <br />Crystal Bay, MN 55323 <br />^ „H I icense fee bond. Cenificate Of Insurance and evidence Of ^CA <br />Sai^n rsr ^ a^:SS M appUcaU;ns are nrbiect ro a ten (10) day approval penod. <br />1. Business or trade name ,~3~^— <br />t r. or-n lj ' V ^ ^ CsDoziness address Cx V ^ 1—hi-Ci-/—V j (city) '‘‘p) <br />(sotet) , . , _ „ .,_____I____ cT ^ . <br />3. <br />4. <br />DUbUICOo auxaa.wj.a '-,i__---------------------------------- ' ' (Clly) <br />. /0/C^ Residence phoneBusiness phone > \ ^ u ^----- <br />.ante of applicant or company represanutiv.s^o.ins;^^ <br />5. <br />6. <br />7. <br />Type of cenification held: _P^I«t Expiration dale: -------- <br />Have you ever held a Septic System Installer license m Otono before? JiD- <br />Most recent year —----------- <br />Have you ever had a license revoked? J\J Q When? <br />Where? <br />8. Do you do Municipal Sewer hook-ups? Yesl^jL. No - - - <br />9. Do you pump out septic tanks? Yes ------- No ^----- <br />SUBMITTALS REQUIRED; <br />1. $50.00 License application fee. «f nmnn as oblieec The State Plumbers^2. $2,000.00 license and permit bond nammg City of Orono as Obligee, in <br />Bond will not be accepted. <br />3 $50-100-300,000 minimum Certific^^f Insurance. <br />Copy of current MFC A Certificate?^^ q ^