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CITY OF ORONO <br />(612) 473-7357 <br />2750 Kelley Parkway <br />P.O. Box 66 <br />Crystal Bay, MN 55323 <br />FEB 2 ^ <br />SITE EVALUATOR/DESIGNER <br />L icense application <br />^ T ff*- and evidence of MPCA Certification must be <br />All qucsiions must be day P'riod. <br />attached. All applications are subject to a ten ( 1 y P <br />1. <br />2. <br />Business or trade name J^C. <br />Business address <br />j. <br />4. <br />Business phone -^727. ‘5 ^.7^ <br />Naane of applicant or company represemative(s) holding MPCA cernficaricn L <br />5. Type of certification held; <br />6. <br />7. <br />Site evaluator /• ^ ^stem designer <br />1 ype or cer lu.wuu. y I_________ <br />Certificate e.xpirauon /y /7Z,z ---------—^ <br />Have you ever performed site evaluation or design work in Orono before? <br />Most recent year --------- <br />Have you ever had a license revoked? <br />Where? <br />When?CIT‘r Cr <br />———”““rr <br />wf “ Auw <br />f *» t r r**J <br />r^rrir* 7L ivv.vw I fuwA »»• A V V • V <br />htitIpr-THANK fvd <br />;i3^SBzO cool ><01 JlvSUBMITTALS REQUIRED; <br />1. SIOO.OO License fee. <br />2. Copy of current MPCA Certificate. <br />licenses will not be processed lentil all items are SUBMITTED <br />The undersigned hereby makes application to of Minnesota <br />perform site evaluation and septic system design subject to the laws or me a <br />and the Ordinances of the City of Orono. a y\ // <br />iOO.iS <br />7 I !l I • « <br />Vs.' <br />Date Applicant ’s Signature <br />*^ m*Hi<i* »>«4i >*«4«4« 3(«^^^]. * m li* 1*1 * an a* ♦^^ <br />CJ7Y recommendation; Approval <br />U5E Reason for denial; <br />ONLY City Council Action; Date <br />Date license mailed <br />Denial <br />Approved <br />Date <br />Denied