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V iHT¥o <br />(612)473-7357 <br />Post Office Box 66 <br />Crystal Bay# MN 55323 <br />SEPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />, ^ ,_License fee# bond» certificate of <br />All questions MPCA Certification must be attached, >^A11 <br />insurance, ”^'^.(£5, lay approval oeriod.applications are subject to a ten a«iy <br />1. <br />2. <br />3. <br />4. <br />Business or trade name r.oPMcO P\UV^6.H fc------ <br />Business address 'S.^OD (pUrtygacv \-<i----------^ <br />Business phone Residence phone _2^2T^ <br />/VlKSS3fc'-l <br />Name o£ applicant or company representative holding MPCA <br />certification VfJ uurry->cC ---------------------------------------- <br />5.Type of certification held; <br />Certificate expiration date Occ 3 \ . \ H m y <br />?\imoerr rrv »"rorfvn <br />............................ * “UlfWc*a I t <br />rr;/Aairr nccrrc <br />t aitr*fVi.Ci wi * awi* <br />6.“‘o7o Mos%*\'e^ce//rear <br />r A A.'iw*V • W <br />7.Have you ever had a license revoked? Qjg <br />Where? _ _ _ _ _ _ ___ _ _ _ _ _ _ _—- - - - <br />When? <br />A i )*rvV a vwiT <br />rixr'r Tt rA M <br />.... ..*. w : . Ti-f # «. f yi ttli«i.w-^ai 1 f I i/ittA f i/w <br />rAAf >*Vf TAT;-•tw'VT w* I V ww'a »%va » v'» •«* <br />VW/ W I / <br />8. <br />9. <br />Do you do Municipal Sewer hook-ups? Yes No <br />Do you pump cut septio tanks? Yes <br />SUBMITTALS REQUIREDs <br />,/i. $50.00 License application fee. <br />^ ^ r\ n 1 «* e* a a mea r*m *L t" bOT- 2 $2000.00 license and permxt bond naming Cit/ o <br />■!: iiii!ss:3o5^?or^ini^;rc*e^ii?rcft:^o^ ?tiuSanis:g:w <br />4^Cooy of cuirzenti MPCA CeiTwificat6* <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARB SUBMITTED <br />The undersigned hereby makes application to °fystemSf <br />Minnesota, for a license to install and repair state of <br />and/or pump out septic tanks, subject to the laws of the St <br />Minnesota ^md the Ordinances of the City of Orono.Minnesota clo.^ v.ai« —----— <br />Date -q<-l . Applicant's Signature (ACuAlyut/Ju^ C <br />CITY <br />USE <br />ONLY <br />Staff recommendation Approval, <br />Reason for denial; <br />City Council Action Date <br />Date license mailed __ _ _ <br />Approved Denied <br />—3:-.