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CITY of ORONO <br />SEPTIC SYSTEM INSTXLLE: <br />(612) 473-7357 LICENSE APPLICATION <br />Post Office Box 66 <br />Crystal Bayr MN 55323 <br />All questions must be answered. License fee, bond, certificate of <br />insurance, and evidence of MPCA 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 />Business or trade name <br />Business address (.cyj A, . s-iTSf <br />Business phone W/ • ^ S’J~ 3 Residence phone g'S~C - 3/f c— <br />Name of applicant or company representative holding MPCA <br />certification Lk. f-------------------------------------------- <br />Installer PumperType of certification held: _ <br />Certificate expiration date __ _ _ _ _ _ _ _ _ _ _ <br />Have you ever held a Septic System Installer license in <br />Orono before? »O Most recent year <br />Have you ever had a license revoked? <br />Where? ______________________ <br />n O When? <br />f ■■ ■■■ " <br />i t i. fc -V'W V'v» <br />,if rrki <br />K'X UL.M <br />f Tf f <br />A 111 .rcki <br />V' A CL. i • <br />r,- <br />«.'V <br />8 <br />9 <br />Do you do Municipal Sewer hook-ups? Yes <br />Do you pump out septic tanks? Yes ______ <br />No <br />I •! I I IT <br />Oi <br />No '>:iCK <br />c*ui I <br />ri 1C-, <br />Aw*'CMC Li' »l- <br />ijcrcTor^ruMik‘ yr <br />i\CCC Ai I » I »nitl\ » C <br />njLV'C*.' <br />SUBMITTALS REQUIRED: <br />$50.00 License application fee. <br />$2000.00 license and permit bond naming City of Orono as <br />obligee. The State Plumbers Bond will not be accepted/ <br />$50-100-300,000 minimum Certificate of Insurance. S^S~'?S' <br />Copy of current MPCA Certificate. <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED <br />List persons other than applicant who are authorized by you to apply <br />for permits under your license $ i r* n f K ,'n C- - - --- --- - - <br />The undersigned hereby makes application to the City of Orono, <br />Minnesota, for a license to install and repair septic systems, <br />and/or pump out septic tanks, subject to the laws of the State or <br />Minnesota and the Ordinances of the City of Ovono,. <br />Date S ~ 3! - y V Applicant's Signature >7^ > ____ <br />CITY <br />USE <br />ONLY <br />Staff recommendation Approval <br />Reason for denial: _ <br />H/Denial Date <br />City Council Action Date <br />Date license mailed _ _ <br />Approved Denied