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iTf OF ORONO <br />(^2) ^ b-7357 <br />2p0 F tUcy Parkway, P.O. Box 66 <br />^sta Bav. MN 55323 <br />0 ’ <br />SEPTIC systt :m lnstallers <br />LICENSE APPLICATION <br />, . w ^ I ff- bond Certificate of Insurance and evidence of NIPCA <br />^ ap“icaj;ns a« subj«t ,o a ten am day approval ponod. <br />1.^ h 1 - /?7 tCdS'^Business or trade name /*/ -------------------— <br />Business address ffl tplt J)yJ 555::^y <br />iSfftet) <br />Business phoneJ. <br />u CiCV) / <br />Residence phone / 7^- / <br />Uip) <br />Name of apolicant or company represemative(s) holding MPCA certification <br />nvi rA rn c /I^a ;______________ <br />5. <br />6. <br />Tvpe of certification held: _Installer imper Expiration date: <br />Have you ever hold a S|p^ystem Insialler license in Orono before? S. <br />Most recent year __/ <br />7.Have you ever had a license revoked? fl 0__ hen. <br />WTiere? ____________________________________ <br />w ^ <br />-------« *•••-• <br />•.wu <br />s. <br />9. <br />Do vou do Municipal Sewer hook-ups? ^es------- <br />Do you pump out septic tanks? Yes ^'o <br />No <br />i. ^ <br />; • f <br />?«%#•••• • ‘-’U <br />• W <br />SLT5MITTALS REQUIRED: <br />^ 1. S50.00 License application fee. <br />2 52,000.00 license and permit bond naming City of Orono as obligee. The State Plumbers <br />Bond will not be accepted. <br />y 550-100-300.000 minimumCertificate of Insurance. <br />[y 4. Copy of current MPCA Certificate. /Q^3/-7S ” <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 your license <br />UBderygned hereby makes applicabou .0 ‘h^Ciyof Orcoo Murnesoo for a H <br />and repair septic systems, and'or pump out septic tanks, subject to the laws of the State of Minnesota <br />and the Ordinances of the City of Orono. ^ 77?/;/? / <br />.Applicant’sSignapare,//(i^^4L'7^^// /la ^^JL oLDate <br />Staff recommendation: Approval <br />Reason for dental: __________ <br />ire// /{(JL/IO^. <br />CITY <br />USE o ,ONLY City Council Action: U^tc <br />mJ Denial Date <br />Approved Denied <br />Date license mailed_