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CITY OF ORONO „ , r \9afiPTic system installers <br />(612) 473-7357 LICENSE APPLICATION <br />2750 Kelley Parkway. P.O. Box 66 ^ <br />Crystal Bay, MN 55323 <br />All questions must be answered. License fee. bond, Certificate of Insurance and evidence of MPCA <br />Cenification must be attached. All applications are subject to a ten (10) day approval period. <br />1. <br />2. <br />3. <br />Business or trade name <br />Business address .36 ? S£ fdor^j roS&-----jVn <br />{Street) <br />Business phone ~/7 4» <br />(city) (lip) <br />Residence phone ^ "7 <^ ~ 3 Si^/ <br />4. Name of applicant or company renresentative(s) holding MPCA certificationne of applicant or company r^resentai <br />E> raA /-/(xy ^ ^ <br />5. <br />6. <br />7. <br />Type of certification held; ^Installer _ Pumper Expiration date: <br />Have you ever held a Septic System Installer license in Orono before? ________ <br />Most recent year _______ <br />Have you ever had a license revoked? /VO When?_______________________ <br />Where?___________________________________________________ <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 />t rrv rv ro~>\>n <br />Will l-'l tx*' (1U <br />.. h,!.jvviL**^ i'l’FICE <br />f »f f *•/»» i *.*i i !-*L A VV'V* <br />«■; CLi <br />SUBMITTALS REQUIRED: <br />r.-| <br />w*V • <br />^ I » w*Vur'iit.A iL <br />YO.. <br />LuOi IfOl h <br />v2.-\ <br />^1. $50.00 License application fee. <br />2. $2,000.00 license and permit bond naming City of Orono as obligee. The State Plumbers <br />Bond will not be accepted. ^ <br />3. $50-100-300,000 minimum Certificate of Insurance.(3itp» <br />4. Copy of current MPCA Certificate. <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED <br />List persons other than applicant w ho are authorized by you to apply for permits under your license <br />---------------------------------------------------------------------------------------------------------- <br />The undersigned hereby makes application to the City of Orono, Minnesota, for a license to install <br />and repair septic systems, and/or pump out septic tanks, subject to the laws of the State of Minnesota <br />and the Ordinances of the City of Orono. <br />Date ^ ^ Applicant’sSignature <br />CITY Staff recommendation: Approval <br />USE Reason for denial: _________________ <br />ONLY City Council Action: Date____________ <br />Date license mailed <br />»♦♦»♦»♦♦♦♦♦»♦♦♦♦♦♦♦**♦♦******♦****** <br />Denial Date ~------- <br />Approved Denied