Laserfiche WebLink
CITY OF ORONO <br />(612) 473-7357 <br />2750 Kelley Parkway. P.O. Box 66 <br />Cr>'Stal Bay, MN 55323 <br />SEPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />1 1995 <br />'I <br />1. <br />2. <br />3. <br />4. <br />Business or trade name_____R A:Ai— <br />Business address M6 . <br />Business phone U2 _____Residence phone------ <br />Name of applicant or company representative(s) holding MPCA certification <br />A/\-f Ci i K) B f l^Lihil <br />5. <br />6. <br />7. <br />Type of cetiiBcaiion held: _ Installer )CPuinper Expiration date: <br />Have you ever held a Sytic System Installer license in Orono before? <br />Most recent year ^ ^________ <br />Have you ever had a license revoked? \)0 _ When? -------------- <br />Where? ----------------- --------------------------------------------- <br />UM <br />8. <br />9. <br />Do you do Municipal Sewer hook-ups? Yes____ <br />Do you pump out septic tanks? Yes ^ No <br />No y <br />I ) I V lit <br />L X t I L‘lc) r i’>ccjrc <br />I AiVr*»*i-*-. u*i I j.c£- <br />f ; 1 ! -, W'^nnA <br />X %JXX V V w.w rryy.K V7UM <br />I 11» <br />ijV • V'. <br />r,-| /V <br />w'V • <br />SUBMITTALS REQUIRED; <br />J^l. <br />"X: 2. <br />3. <br />4. <br />I ’ 7j C" 11 / It <br />t-llucA iL CX'»V\ <br />s.; w ll-*T«- i Yllij <br />4 4 . - .11 .» »*1 •! 'r'l } J ; f 4 .*V' i.Vwi IIV'A <br />$50.00 License application fee. c oi k <br />$2,000.00 license and permit bond namine City of Orono as obligee. The State Plumbers <br />Bond will not be accepted. £>tp- <br />$50-100-300.000 minimum Certificate of Insurance. typ,,6v»“ <br />. -r. Copy of cunent 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 permits under <br />i\^at\o G\oilt\a ,ic <) -tacu^iu.ei. -. iM(trrrU Ji./ <br />a . • € <br />The undersiened hereby makes application to the City of Orono, Minnesota, for a <br />»d repa" «ptic systems, and/or pump out septic tanks, subject to the laws of the State of Mmnesota <br />and the Ordinances of the City of Orono. <br />n^fp Annlicant*sSignature <br />CITY Staff recommendation; Approval Denial-------- Date t /fV « ^----- <br />USE Reason for denial: _____ <br />ONLY City Council Action: Date <br />Date license mailed <br />Approved Denied