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CITY OF ORONO -uS'ySiu™ <br />(612) 473-735/ ^ FFR 2 11995 <br />2750 Kelley Parkway, P.O. Box 66 rtb i <br />Crystal Bay, MN 55323 ^ - • •-• ::,v:riO <br />A T ;rrnse fee bond, Cenificaie of Insurance and evidence of MPCA <br />Sron be'a'Srh". ■ All application, are subject to a ten (10) day approval period. <br />Business or trade name ~^V^^m'pF-r--------------------1. <br />3. <br />4. <br />address nr\ <br />Residence phone _ <br />ifNerVo< <br />(Z'P) <br />0. <br />6. <br />(strcsJ <br />Business phone ~ H*~11 *1]-------- <br />Name of applicant or compa.y representative(s) holding MPCA certif.cation <br />"TKorrygc-. ---------------------- <br />Typeofc=nincationheld:Xl““"« _P“”F" Expiration date: M-^1 rM <br />Have you ever held a Septic System Installer license in Otono before? t^Sjs <br />Most recent year _______ <br />7.Have you ever <br />Where? <br />had a license re .’cked? K\!^__ Wnen? <br />I • W* UlVWitU* <br />8. <br />9. <br />Do you do Municipal Sewer hook-ups? Yes ^ <br />Do you pump out septic tanks? ^es -------- <br />No <br />No A <br />C r *. f .•*' 1 t ; w • I *• <br />/ Wl •• AWte <br />iJaa-vvvvv <br />i-tiK Ti :-v'.. <br />,xiu£i'Pr-/r«vA rTw <br />SUBMITTALS REQUIRED: <br />2: $2d3OT.OT “«^e‘’S "^8 City of Orono as obligee. The State Plumbers <br />—^ Bond wUl not be accepted. T'if> ^ <br />V 3 $50-100-300,000 minimum Certificate of Insurance. <br />^ 4 Coov of current MPCA Certificate. <br />*T • j <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED <br />and the Ordinances of the City of Orono. ✓ .-i 7 <br />JD . Applicant ’sSignatuie <br />city Staff recommendation: Approval <br />USE Reason for denial: _____ <br />ONLY City Council Action; Date <br />Date license mailed <br />Approved Denied