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C ity of orono <br />(612) 473-7357 <br />2750 Kelley Parkway, P.O. Box 66 <br />Crystal Bay, MN 55323 <br />SEPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />Business or ti ade name S ?.—CLi —Sf rO/c^ ^ <br />Business address <br />(itreet) <br />fk/cLiy ^tk <br />(w) <br />Business phone ^7.?-Residence phone 4> ^ <br />(up) <br />(*me of applicant or company tcprcsemalive(s) holding ^l^rcA certiftcalion^^ <br />f <br />Type of ccnification held: jv^stallcr j^umper 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? . a J .^ When? <br />Where? <br />8. Do you do Municipal Sewer hook-ups? ^es ., 1<1 <br />9, Do you pump out septic tanks? Yes <br />SUBMITTALS REQUIRED: <br />A .1. »».***( tc u i L t» <br />i \ i i L*i'i» i» iri*},..aac-vvvvv <br />M i'tit <br />Tii u V't vv <br />1®. <br />i!0i /ii-'l riJ- <br />,*i. • f*.». <br />t Tl.eS.ateP,umbers <br />Bond will not be accepted.^^- . J-'VJC <br />3. $50-100-300,000 minimum Certificate of Insurance.^yp li <br />4. Copy of current MPCA Certificate. <br />licenses will not be processed until all items are subnutted <br />List persons other tlian applicant who are^authorized^by you to apply for permits under your license <br />PA L , lUy --------------------------------- <br />The undersigned hereby mokes application to the City of Orono. <br />aiid repair septic systems, and/or pump out septic t^, subject to the laws of the Stat <br />and the Ordinances of the City of Orono. ^ ^ ^ <br />Date Applicant’'Signature <br />......................................... <br />Staff recommendation: ApprovalCITY <br />USE <br />ONLY <br />Denial D»ic_2r22^ <br />Reason for denial: <br />City Council Action: Date <br />Date license mailed_____ <br />Approved Denied