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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 />SEPTIC SYSTEM INSTALLERS <br />FEB 2 3 license application <br />JJCijr , ----------------- <br />1. <br />2. <br />3. <br />Business or trade name —--------------------- e ^ o <br />5921 Dague Avenue S.E. Delano, MN. 55328 <br />Business address <br />(snw) _ ^ <br />^ 471-8151Business phone____________ <br />Residence phon^^HllH^ <br />(np) <br />4. <br />- C»^> I* <br />5. <br />6. <br />Type of cenific*a6on held: J Imtaller jc^mper Expiration date: <br />Have you ever held a Septo System Installer license in Orono before? <br />Most recent year_____ <br />Yes <br />7.Have you ever had a license revoked? — <br />Where?_____________ <br />When? <br />^ 8. <br />9. <br />Do you do Municipal Sewer hook-ups? Yes _X_ <br />X <br />Do you pump out septic tanks? Yes------- <br />Clfr OF lRv^O - -r-rr. <br />i 3i:5i'vvvt-_ <br />- : s t <br />w* V • W <br />STA .V <br />w* V • V <br />SUBMITTALS REQUIRED: <br />t I ! • ^ ^ <br />VJ. <br />wvvx nvi <br />v>/ 1. $50.00 License application fee. •„ r;n/nf Drono as obli^'ce. The State Plumbers <br />“7^ 2 $2,000.00 license and permit bond nam^ City <br />r. ' Bond wUl not be accepted, ficp q-lJK* <br />3 $50-100-300,000 minimum Certificate of Insuran 1 I^i-> <br />A nf riirrent MPCA Certificate. <br />X ^ ------------------------ <br />4 Copy of current MPCA Certificate. <br />licenses will not be processed until all items are submitted <br />. r-_____nnH#»r vour li <br />LICLN^t-a I'.vy* ---------------- <br />List persons other than applicant who are authorized by you to apply for permits under your lice^e <br />Viola Braeaelmann. Marv JQ BrRPqplTTinaa—- -Viola Braeaei iRi^nn . nn t y uw ---------------- <br />S: Se^ Ss.”a^^r"p^; ou" ^P^ S °:^^S°toSrol sroTM^- <br />and the Ordinances of the City of Orono. -------- <br />2-17-95 <br />Date___________Applicant’s S ignaturj^^ <br />w ♦**»»*#♦ <br />. /vfti <br />CITY <br />USE <br />ONLY <br />Staff recommendation; Approval^^£2L/ <br />Reason for denial; _____ — <br />City Council .Action; Date <br />Date license mailed <br />ac D!« an Jic :|c :*c ai» ^ 5^ * <br />Date <br />Denied