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r <br />L <br />CITY OF ORONO <br />(612) 413-7351 <br />2750 Kelley Parkway, P.O. Box 66 <br />Crystal Bay, MN 55323 <br />SEin iC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />1.Business or trade name k j___(?n “?t ix-----^ <br />Business address t-318- <br />3. <br />(Street) <br />Business phone ^17^._____Residence phone------- <br />(lip) <br />4.Name of applicant or company rcpresentative(s) holding MPCA certification <br />A A>» ✓ V //«.«v —v<?y -r.^------------—----------------------------- <br />5.Type of cenification held: /insuller _ Pumper E.xpiraiion dale: . <br />6.Have you ever heid a Septic System Installer license in Orono before? <br />Most recent year_____________ <br />1.Have you ever had a license revoked? t^o _ hen? <br />Where? __________________________________ <br />8. <br />9. <br />Do you do Municipal Sewer hook-ups? ^es <br />Do you pump out septic tanks? Yes ____ <br />No CITr OF iji<OSO: vpf.Viu r .jLcjrcr xf fnnL L, <br />A Ji A VvV <br />•’mk <br />< rs*iV'A <br />L’.Y A <br />TiI L, <br />SUBMITTALS REQUIRED: <br />bond naming City of Orono as obligee. The State Plumbers <br />Bond will not be accepted. 6<p. ^ <br />jy/3. S50-100-300.000 minimum Certificate of Insurance, 6'OU“'7S^ <br />i/^4. Copy of current MPCA Certificate. <br />w'V'* <br />^» » <br />w* V' • VLIIU.-.. -------- <br />RFCEIFT-lHf^K YOU <br />i;311250 iOOl ROi U4 <br />/TC /• f I' <br />VW.V•/ A A <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED <br />List persons other than applicanl who are authorized by you to apply for permits under your license <br />^ II n . ---------------------------- <br />The undersigned hereby makes application to the City of Orono. | <br />and repair septic systems, and/or pump out septic tanks, subject to the law <br />and the Ordinances of the City of Orono. <br />Date %/ ? V <br />Staff recommendation; Approval Denial------- Date----Q I -----------CITY <br />USE <br />ONLY <br />Reason for denial; <br />City Council Action: Date <br />Date license mailed_____ <br />Approved Denied <br />1