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CITY OF ORONO <br />(612) 473-7357 <br />2750 Kelley Parkway, P.O. Box 66 <br />Crystal Bay, MN 55323 <br />HHCE ’iV ED SEPTIC SYSTEM INST/VLLERS <br />. ^ LICENSE APPLICATIONAOC 1 6 199^ <br />(jlfYCF ORONO <br />All auestions must be answered. License fee, bond, Certificate of Insurance and evidence of MPCA <br />cLmcatL must be attached. All applications are subject to a ten (10) day approval period. <br />1. Business or trade name Xfu'c. <br />3. <br />Business address <br />Business phone f,!.:; gtjl-______Residence phone------------------------------------- <br />4.Name of appiicant or company .epresentative(s) holding MPCA certification <br />A- 1-^ /O <br />5.Type of certification held: _ Installer V Pumper Expiration date: /J-.3I-9L-. <br />6.Have you ever held a Septic System Installer license in Orono before? N'O-hda j?H/^^^ZiLV • <br />Most recent year ^13 ________ / <br />7.Have you ever had a license revoked? When? <br />Where? <br />8.Do you do Municipal Sewer hook-ups? Yes No <br />9. Do you pump out septic tanks? Yes _2^ <br />SUBMITTALS REQUIRED: <br />Cijy OF CFO^iQ <br />office <br />1311500000ni rrv <br />VI crt.li <br />rV <br />W'C' • VV <br />r,i />.* <br />W*v • V'CiiiEK Ji i.cr c f »:• r_ ru A»?y yni » <br />yC 1. S50.00 License application fee. . ' . m- T13 ’ <br />Y, 2. $2,000.00 license and permit bond naming City of Orono as obligee. «- > 03/16- <br />Bond will nm be accepted <br />_ _ _ _ ^ __& <br />Bond will nm oe accepieuaf*.^ ^ <br />3. $50-100-300.000 minimum Cenificate of Insurancel^p.>-fti <br />Y 4. Copy of current MPCA Certificate. <br />LICENSES WILL NOT BE PROCESSED UNTU. rVLL ITEMS ARE SUBMITTED <br />List persons other than applicant who are auAorize^by you to apply for permits unuer your license <br />Alflt y <7rg/g-e>4-nJQ__Joh “ <br />The undersigned hereby makes application to the City of Orono. Mi"'J”: M°ni«ota <br />and repair septic systems, and/or pump out septic tanks, subject to e <br />and the Ordinances of the City of Orono. <br />£Date ___Applicant’sSignature^^>L^r; <br />CITY Staff recommendation: Approval Denial------- Date-------/ 7% <br />USE Reason for denial: _____ <br />ONLY City Council Action: Date <br />Date license mailed <br />f\pproved Denied