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CITY V t)RONO oTtor ] <br />aioNO ^ iDie____mlsenQ’^^^SEPTIC SYSTEM INSTAIXZRS <br />LICENSE APPLICATION(612) 473|;7/57 <br />Post: Office Box 66 <br />Crystal Bay, MN 55323 iqq:; <br />rv - p 9 8 . . » <br />All -questions must be answered. ltiPc^n«e fee^t^ bond, certificate of <br />insurance, and evidence of MPC7. Certification must be attached. All <br />applications are subject to a ten (10) day approval period. <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />Business addrass <br />Business or trade name ^ A/C K ~/X ^ ^ g- 5 <S ^ ^ <br />Business phor- -'6-/^0 Residence phone *47^^. f ^ <br />Name of applicant or comoany representative holding MPCA <br />certification F- —----------- <br />PumperType of certification held: Installe^ <br />Certificate expiration date Dec> /7f€ <br />Have you ever held a Septic System Installer license in <br />Orono before? Most recent year ------- <br />Have you ever had a license revolted? A/^ <br />Where? __ _ _ _ _ _ _ _ _ _ _ _ _ ___ _ _ _ ___ _ _ _ _ <br />When? <br />Do you do Municipal Sewer hook-ups? Yes <br />Do you pump out septic tanks? Yes _ <br />No K <br />rTT'v nC nii^riUii wall wi i/nuifurrvA#;rr r#rrrrrf xnntfLfim I A W4.1f 7f .........A WA <br />SUBMITTALS REQUIRED <br />01 Ti <br />e.A M <br />W50.CHECKKECEIPT-THm YOU <br />M293640 cool iiOl T09:t <br />I/''If S50.00 License application fee. 12/29/9 <br />'J^2. $2000.00 license and permit bond na^ng ° g: <br />— ^ obliqee. The State Plumbers Bond will not be accepted.iaip.xl.-'Bxp.'A?/ <br />LICENSES NILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED <br />List persons other than applic^t who are au^orl^ed by you to apply <br />for permits under your license —- - - - - - -" <br />The undersigned hereby makes stems ^ <br />Minnesota, for a ^subject tS the laws ot the SMte of <br />rini::L?rind“thrrrd!nrn«i' =f t?.e eg of Orono. <br />Date /-X Applicant's Signature <br />CITY <br />USE <br />ONLY <br />Staff recommendation Approval ® <br />Reason for denial: _ _ ___ _ _ _ _ _ <br />City Council Action Date _ _ _ _ <br />Date license mailed_ _ _ _ _ _ _ __ <br />Date <br />Approved Denied