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ClTYof O^pNO <br />(612) 473-735? / <br />Post Office STO3/66 <br />SITE EVALOATOR/DESIGNER <br />LICENSE APPLICATION <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 />Business or trade name iJjt ILC p. •/' '* f',41 <br />Business address ‘Si J-Zw (. ^ <br />Business phone 1 ^ Residence phone <br />4.Namo of applicant or compan' representative(s) holding <br />certification A- > h-' • ~~ r-,\ //U: J <br />5. Type of certification held:Site evaluator System <br />designer. Certificate expiration I <br />6. Have you ever performed site evaluaticm or design work in <br />Orono before? Most recent year _//: (/ / <br />1 <br />7.Have you ever had a license revoked? <br />Where? <br />/v.(When? <br />.'VTV -r <br />I 1 U‘) UMU'MW <br />SUBMITTALS REQUIRED <br />I w» • -4C4- <br />i V ? ^ Va ki/ 4 4 W*VV^ wv <br />V4 euif 4W^«W <br />1. $100.00 License application feo. <br />2. Copy of current MPCA Certificate. <br />L <"fi w A TL 100 . V'. <br />fTiwuar I f I I vu <br />f»w ‘Vw*Juv LW4 .?W>4 I VI* <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED r, f ( <br />V w*/ 4 4 <br />Date <br />The undersigned hereby makes 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 />/ , ^: / 7/- V Applicant's Signature <br />Staff recommendation Approval <br />Reason for denial: <br />Denial Date <br />City Council Action Date <br />Date license mailed <br />Approved Denied <br />i