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BiTY of ORONO 52P7IC SYSTEM INSTALLERS <br />1 8 “^99A I.ICENSE application <br />cnv OF OBO^^O(612) 473-7357 <br />Post Office Box 66 <br />Crystal Bayr MN 55323 ^ ^ ^ <br />j fee* bond/ certificate <br />All questions mist be certification niust be attached. All <br />insurance, and (10) day acoroval period,applications are subject to a ten UJ; aay .. <br />1. <br />2. <br />3. <br />4. <br />Business or trade name —o-\ v j J — <br />Business address ^-- -y- - - - --- -—- - - -. - - - - - - - - - - <br />^ Residence phoneBusiness phone -- - - - - --- - - <br />• t_ ^ *1 ^ m <br />^- -—- - - - - - - - - - - - - - - - - - - - - <br />of applicant, or ==n-Pany, Holding <br />certification d v ^ A —--------------------- <br />5.Type of certification held: <br />Certificate expiration date <br />>C Installe <br />~U3l <br />Pumper <br />6. <br />w ^ ^ <br />Have you ever held a Septic System Installer license in <br />orono before? _ Most recent year ----------- <br />7.Have you ever had a license revoked. <br />Where? <br />8. <br />9.Do you pump out septic tanks? Yes <br />When? <br />i;;r I'/UKUNU <br />No <br />r X iVrrf^c w <br />/• 7 • <br />Lv I AW U <br />i c:.A A.- <br />.-•U' ■ v\ <br />> <br />V * ww . . <br />f-.-tfA TL <br />^ i^cEiPT-TH^ygu^^ <br />lYiAlJiL’a ;11- <br />vJ/ AW' <br />SlcrSr^iflc^e. ■ <br />licenses will hot be processed 0HT1L ALL ITEMS ARE SUBMITTED <br />List persons other than applicani^-.o^are ^^P^^horired by you to app 1 <br />for permits under your license . ^ <br />Date <br />eXlU-LUO ^- - - - - - - <br />The undersigned hereby " eVair*septic systems, <br />Minnesota, for a license to instil ^o tS^laws of the State of <br />Minnesota and the Ordinances of the City^ ^ / jT /// <br />Applicant's Signature <br />5taff recommendation Approval Oenial <br />CITY Reason for denial: - - -——— <br />^ m_ _L_ 1 <br />Date <br />USE <br />ONLY <br />- - - - - - <br />City Council Action Date <br />Date license mailed _ _ _ <br />Approved Denied