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iilL.>' f cmrcFcrc\o =31r J <br />SITE EVALUATOR/DESIGNER <br />LICENSE APPLICATION <br />'JUL ^ i 1995 <br />CITY OF ORONO <br />(612) 473-7357 <br />2750 Kelley Parkway <br />P.O. Box 66 <br />Crystal Bay, MN 55323 <br />All questions must be answered. License fee and evidence of MPCA Certification must be <br />attached. All applications are subject to a ten (10) day approval peno . <br />Business or trade name <br />(street) / ^ iy 1 ^ <br />Business phone (d\. y Residence phone------->-2 »U .y2-------------- <br />Nameof applicant or company representati^s) holding MPCA certitication-------------- <br />------------------------------------------------------------------- <br />Type of certmcacion held: hie evaluaiof(»r^ ___System designer <br />Certificate expiration __________________---------------------C-P^X-------------------- <br />1. <br />2. <br />3. <br />4. <br />Business address <br />5. <br />6. <br />7. <br />Have you ever performed site evaluation or design work in Orono betore.- —y <br />Most recent year <br />Have you ever had a license revoked? /V^ _ Wlien? ------------------------ <br />Where? _____________________________________—-------- <br />SUBMITTALS REQUIRLl): <br />[. SI00.00 License fee. <br />2. Copy of current MPCA Certificate. <br />.T.tr* <br />. w. . . V - <br />Ti-rru <br />C I XL <br />r * aT. •» m <br />LICENSES WILL NOT BE PROCESSED UNTIL .ALL ITEMS ARE SUBMI H L. <br />Tlie undersigned hereby makes application to the City ot Orono, Minnesota, tor a license to <br />perform site evaluation and septic system design subject to the laws of the State of Mmnesou <br />and the Ordinances of the City of Orono. ^ ^ <br />•. II.-rr^-r <br />.r- ♦ ^ <br />u * V* t L'V <br />.. ;i- .r,li <br />7. <br />J . ■ ■ 1 w* • <br />n.ate rSA Applicant’sSigna’sSicnaKre <br />CITY Staff recommendation; Approval Denial____ Date / ^ — <br />Reason for denial: ___________________USE <br />ONLY City Council .Action; Date <br />Date license mailed_____ <br />Approved Denied __