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CITY OF ORONO <br />(612) 473-7357 <br />2750 Kelley Parkway, P.O. Box 66 <br />C^^'SUll Bay, NIN 55323 <br />H T !«nse fee bond. Cenificnte of Insurance and evidence of MPC.\ <br />All questions must be answered. subject to a ten (10) day approval period. <br />Certification must be attached. All applicatio ^ ^ <br />1. Business or trade name firll fn Ttic <br />Business address l/W Sh kadiL <br />(strttU ^ <br />J. <br />4. <br />Business phone ~~7 2 "7 I ^ ^ <br />Name of <br />(City) U:pj <br />Residence phone ^ ----- <br />f^pplican. or compt^y repres«.ative(s) holding MPCA certif,cation <br />e. if IL—Oh^--------------------- <br />5. <br />6. <br />7. <br />8. <br />9. <br />Type of certiftcation held: ^ Installer _ Ihrmper 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? — When. _ - <br />Where? ----------------------------------------------------------------- <br />Do you do Municipal Sewer hook-ups? Yes _2)C- <br />Do you pump out septic unks? Yes ------ <br />0^ - 9 :T <br />-----. -‘r-r~r^g <br />' '..’i'- *—i-V-- <br />- * • ij-'J tv'. <br />. ti.* <br />u »- s u . - ; — . ••‘—•.N • '.‘V <br />SUBMITTALS REQUIRED: <br />K: 1. S50.00 License application fee. ^ Plumbers <br />—2 S2.000.00 license and permit bond lumu^C ty <br />Bond wUl not be accepted. <br />■J 3 $50-100-300.000 minimum Certificate of Insurance. ‘j.-fS-rS <br />4 Copy of current MPCA Certificate. <br />licenses will not be processed until all items are submitted <br />List persons other chan applicant who ate authorized by you to apply for pemuts under your hc^ <br />and the Ordinances of the City of Orono. - ^ <br />Date V- lill^^ApplicanfsSignature ^ <br />/-T-rv Staff recommendation: Approval Denial------------------------- <br />Tjcc Reason for denial:-----------------------------------------Annroved Denied <br />ONLY City Council Action: Date ------------Approvea <br />Date license mailed