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CITY of ' JllONO <br />u\___p—2___! <br />JAN 1 3 1994 <br />SITE KVM.OATOR/DBSIGKER <br />LICENSE APPLICATION(612) 473-735/ <br />Post Office Box 66 <br />Crystal Bay, MN 55323 <br />All questions must be answered. License fee and evidence of MPCA <br />Certification must be attached. All applications are subject to a ten <br />(10) day approval period. <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />Business or trade name ^Sapi <br />Business address t*^Vr(iyv s4, <br />Business phone Residence phone S O^^^yyJU <br />Name of applican <br />certification <br />It or company representative(s) holding MPCA <br />Type of certification held; ^ Site ^alua^r ^ System <br />designer. Certificate expiration 7________________ <br />Have you ever performed site evaluation or design worlc in <br />Orono before? y\n Most recent year ___________ <br />Have you ever had a license revoJced? <br />Where? ______________ <br />D when? <br />SUBMITTALS REQUIRED; <br />1. $100.00 License application fee. <br />2. Copy of current MPCA Certificate. <br />-------c:rr gr vntano <br />FIfJA.iCE OFFICE <br />1311^:00000 <br />01 QEH 100. OC <br />CW IL 100.00 <br />RECUPT-THm YOU»ai ns: <br />The undersigned hereby ma)ces application to the City of Orono, <br />Minnesota, for a license to perform site evaluation and septic <br />system design subject to the laws of the State of Minnesota and <br />the Ordinances of the City of Orono. <br />Date ^ /^^7j/Applicant' s Signature ^wstaff recommendation Approval <br />Reason for denial; <br />Denial Date /-/‘MV <br />City Council Action Date <br />Date license mailed <br />Approved Denied