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nTrnunNro - • " septic system installersCITY Ur UKUiNU ^ . license application <br />(612) 473-7357 -j <br />2750 Kelley Parlo ’ay, P.O. Box 66 . ... <br />Crystal Bay, MN 55323 - <br />u T icense fee bond. Certificate of Insurance and evidence of MPCA . <br />cinSoa ZcM.' AU applications are subject to a ten (10) day approval period. <br />1. <br />2. <br />J. <br />Business or trade name C .^A'C - <br />Busutess address <br />BusinessphoneRcsMencephone m.i------------ <br />N^e of applicant or company teptesentative(s) holding MPC.A cettification <br />--------------------------------------------------------------- <br />i... .. r-.nitv.tion held: ^.Installer :k^mper Expiration date: /A ^ ----- <br />6. <br />•ft <br />Have you ever held a Septic System Installer license in Orono before? ^ <br />Most recent year ---------- <br />7.Have you ever <br />WTiere? <br />had a license revoked? When?..--------- <br />%,‘A f f Wl UJ WMUt <br />8. <br />9. <br />Do you do Municipal Sewer hook-ups? Yes ------- <br />Do you pump out septic tanks? Yes — No <br />No ^ <br />iWA X w'VVV'W <br />. >----------. t. <br />U i- m i I •kXmU <br />L' 1 ouiV•-rrv*IL <br />w* • <br />' <br />WV' « <br />’ hLlIPT-T^^K YCi <br />4'nOl^O IVi/'i tSir’L'/. <br />I A ; <br />V <br />submittals REQUIRED: <br />^ ?: l°0OT.OT"SLe'’a'id“Fi^™it5on^ of °™"0 as obligee. The State Plumbers <br />Bond will not be accepted, 16 <br />3. 550-100-300,000 minimum Certific^ of Insur^ce. ,D>P' » ^ <br />Copv of current MPCA Certificate.X <br />licenses wtll not be processed until all items are submitted <br />List persons other than applicant who are authorized by you to apply for permits under your license <br />The undersigned hereby makes application to the City of of Minnesota <br />and repair septic systems, and/or pump out septic tanks, subject to the laws of the bta <br />and the Ordinances of the City of Orono. <br />CITY Staff recommendation: Approval <br />USE Reason for denial: <br />ONLY City Council Action: Date <br />Date license mailed_____ <br />Approved Denied