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CITY OF ORONO <br />(612) 473-7357 <br />2750 Kelley Parkway. P.O. Box 66 <br />Crystal Bay, MN 55323 <br />SEFFIC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />All questions must be answereti. License fee, bond, CeniHcate of Insurance and evidence of MPCA <br />Certification must be attached. All applications are subject to a ten (10) day approval period. <br />1.Business or traile name k.hax' <br />Business address ------------------------------- <br />(Street)(lip) <br />3. <br />4. <br />Business phone __Residence phone <br />MPCA certification <br />o/>/) <br />5. <br />6. <br />Type of certification held: i^Installer (^Pumper Expiration date: jf/73 f <br />Have you ever held a Septic System Installer license in Orono before? ---------------- <br />Most recent year y <br />7.Have you ever had a license revoked? /Vd 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 />SUBMITTALwS REQUIRED; <br />1. $50.00 License application fee. r oi k <br />2. $2,000.00 license and permit bond naming City of Orono as obligee. The State Plumoers <br />Bond will not be accepted. <br />3. $50-100-300.000 minimum Certificate of Insurance. <br />4. Copy of current MPCA Certificate. <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED <br />List persons other than applicant who are authorized by you to apply for perries under your license <br />The undersioned hereby makes application to the City of Orono, Minnesota, for a license to install <br />Ld repatr septic systems, and/or pump out septic tanks, subject to the laws of the State of M.nnesom <br />and the Ordinances of the City of Orono. <br />Hate ^ ^ Applicant’s Signature <br />... . <br />CITY <br />USE <br />ONLY <br />Staff recommendation: Approval <br />Reason for denial: <br />Denial <br />City Council Action: Date <br />Date license mailed <br />Approved Denied