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1 <br />"" “t^Yof ORONO <br />(612)473-7357 <br />Post Office Box 66 <br />Crystal Bayr MN 55323 <br />SEPTIC SYSTEM INSTALLERS <br />LICENSE application <br />AIL questions Bust be answered. License fee, bond, certificate of <br />insurance, and evidence of MPCA certification must be attached. .^All <br />aSolilations are subject to a ten (10) day approval period. <br />1.Business or trade name ^*I'^-------- <br />-. ,, /2,rs/ D SLu k(i,oc,c2.Business address C>^ ^ —------------------^--------------- <br />5. <br />8. <br />Business phone ~72 3 ^7/^^ ^ Residence phone _tLdlZJ2L2^ <br />Name of applicant or company representative holding MPCA <br />X Installer ____ <br />(W ms- <br />Piimoer <br />certification <br />Type of certification held: <br />Certificate expiration date <br />Have you ever held a Septic System Installer license in <br />Orono before? Most recent year — <br />Have you ever had a license revoked? —— When? - - - - -- <br />Where? ___________________________—----------------------------------------“ <br />Do you do Municipal Sewer hook-vps? Yes <br />Do you pump out septic tanks? Yes . <br />rrrv r>c rron«Aiwa f I u'MbrtTu <br />LrhiAiurL nccrrcI aimftu'i. wi I auu <br />Copy of current MPCA Certificate. <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITOIS ARE SUBMITTED <br />List persons other than applicant who are authorized by you to apply <br />for permits under your license liio/c Li'V\eAC^.---------------------------------------- <br />The undersigned hereby makes application to the City <br />Minnesota, for a license to install and repair seP^ic q£ <br />and/or pump out septic tanks, subject to the laws of the State or <br />Minnesota and the Ordinances of the City of Orono. <br />Date V~ /2. - f •/Applicant's /2^ <br />CITY <br />USE <br />ONLY <br />Staff recommendation Approval <br />Reason for denial: <br />Denial Date <br />Cit: Council Action Date <br />Date license mailed _ _ _ <br />Approved.Denied