Laserfiche WebLink
LLERS <br />mo <br />•crrc <br />I <br />t*U'■vv <br />r/-i ^vvv <br />V vrrfit\ »ww <br />VI I * <br />vw/ i V/ <br />CITY of septic system INSTAIXERS <br />LICENSE APPLICATION <br />(612)473-7357 <br />Post Office Box <br />crystal Bay, MN ->license fee, bond, certificate of . <br />All Questions must be Certification must be attached. All <br />insur'ance, and evidence of^approval pertod. <br />applications are sub]ec ___ y4^ <br />1 <br />r <br />Business or trade name^ <br />-y^/ ■y Q <br />Business address —^^ ■Business address . ^ -- - - - - <br />3u=ines. <br />...e of ‘-:!i <br />ce <br />T-nse Of c:ertification^held^ -/^ <br />Certi. - cate expiration date _ / <br />Pxinper <br />Hav» vou ever held aHav> ^ Most recent yea- <br />tialL^r license <br />Orono before? <br />v.3,^ a license revoked?Have you ever had a x-cense ___^ <br />Where?_____________—-------------- <br />30 you do Municipal Sewer T.oon-ups? fes . <br />30 you puiap ouc septic tanks? Yes ___ <br />When?*r "crfhri.ail wi w*Mw*iti/ <br />\:rr *ccTpc <br />I t- Cl I 1 wc <br />•• - 1 •4 A A A1311500000 <br />—V 1 <br />rUCrk; 71 <br />wKCUii^ <br />No ^I i ?w* V • Vr.% r <br />V <br />-rrrroT.7L.A;;;* vri/j <br />f •rl»rTMl% 1 VU <br />* V > 4. r* ? f “»f > J r J -yrJvvC'aV * ^2 <br />06/1. <br />SUBMITTALS REQUIRED: <br />A.S50.00 License naming City of Orono <br />—^n S2000.00 license and permit ° w-f ’ 1 net be accepted.ro^licee. cne State Plumpers rona wr i <br />,iso-ioc-soo.ooo siinitnum Cer.--C-t- c <br />r CODV of current MPCA Cartrircate. <br />" .XC^S.S WXLL .or B. PBOCBSSHO 0»XXL ALL X.BHB ABB SOBMX <br />r.iet oersons other than applioa^------- <br />for permits under your license r ^ZT/TIT^ono. <br />The undersigned hereby V„d° reoair e«P'=i'= %\XTle <br />Minnesota, for a license to xn^-all of the State o <br />Minnesota^ and t.he Ordinances of the sT/ <br />^ ~ /Applicant's SignatureDate <br />CITY <br />USE <br />ONLY <br />City Council PiCtLan <br />Date license mailed <br />Date Approved <br />Date <br />Denied