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CITY OF ORONO <br />(612) 473-7357 FEB 2 2 199^ <br />2750 Kelley Parkway ^ « <br />P.O. Box 66 <br />Crystal Bay, MN 55323 <br />^ I i«nse fee and evidence of NfPCA Cenification must be <br />^;!iched“°iS!l “pncatio^^e subject to a ten (10) day approval period. <br />1. <br />2. <br />a. <br />4. <br />5. <br />6. <br />7. <br />, ^ US~4:»’^S .—Iv^vCBusiness or trade name__—l------------------ <br />0^1 .A\(L lo..Ni-Business address ^(city) <br />Business phone------R«idencephone---------------_ <br />Name of applicant or company represemat.ve(s) holding NIPCA certification <br /><4vo^.■^ <^fU.r.wa.^------------------------------------ <br />(Zip) <br />Type of cemficaiion held: <br />Certificate expiration <br />\y Site evaluator H_System designer <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? <br />ilTr CF <br />r j. rVrT.i <br />f VH i >» <br />■ “tlS......,''!.,.i v-X.v-SUBMITTALS REQUIRED: <br />^ 1. $100.00 License fee. % <br />—^2. Copy of current MPCA Certificate. - • i- <br />UCENSES ^VILL NOT BE PROCESSED LOTIL ALL TTEMS ARE SUBMITTED <br />The undersigned hereby makes '^^t1oTraws^T^.'"om <br />nerfotm site evaluation and septic system des.gn subject to the laws ot the <br />and the Ordinances of the City of Orono. ^ // <br />.9-JI-^*^ Applicant's Signature ------------------------- <br />—-..........***”**********^’T*n**T***'** dIw**22^CITY Staff recommendation: Approval Dema ------- <br />USE Reason for demal: --------------------------Aooroved Deni^ <br />ONLY City Council Action: Date ------------_ Approve <br />Date license mailed