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r/u34 •CITY OF ORONO septic system instaj t i?rs(612) 473-7357 LICENSE APPLICATION <br />2750 Kelley Paricway, P.O. Box 66 <br />Crystal Bay, MN 55323 <br />AU quesUons must be .nswered. Ucense fee, bond. Ceilinatc of Insurance and evidence of MPCA <br />Ccrtificalion must be attached. All applications are subject to a ten (10) day approval period. <br />1. <br />2. <br />3. <br />4. <br />fSt-y <br />:irv) (*^P) <br />RiKineMphona . Residerrce phone <br />N^e of applicant or company representativc(s) holding MPCA ceiiification <br />Pa(a\^^ ______—------------------------- <br />5. <br />6. <br />Type of certification held: 2$>Installer ^Pumper Expiration date: <br />Have you ever held a Septic System Installer license in Orono before? ...UjCj <br />Most recent year_____________ <br />7. Have you ever had a license revoked? When? <br />Where? ' . ---------------------- <br />8. Do you do Municipal Sewer hook-ups? Ye.s <br />9. Do you pump out septic tanks? Yes _____ <br />No i \H-Anu^Aa tJi a w*w vw <br />No V- <br />V' a 1 =-r} ,• <br />Vruvrk' Tit-ricin lu iw*V*w <br />w'V <br />t-.-j r <br />SUBMllTALS REQUIKED; <br />/itit IPT~ s HiMucuat I 11 tnntx » <br />rrw*aV L-W'a Mv'a » v-'L <br />(\Q /vfV'7/ iLV <br />“y' 2. permit bond naming City of Orono as obligee. The State Plumbers <br />Bond will not be accepted, ^9~9^ __ <br />>( 3. $50-100-300,000 minimum Certificate of Insurance. <br />V 4. Copy of current MPCA Certificate. <br />LICENSES WILL NOT BE PROCESSED UNTIL ALT. ITEMS ARE SUBMITTED <br />List persons,other than applicant who are authorized by you to apply for permits under your license <br />C^.stdA.^ --------------------------------------------------------- <br />and the Ordinances ot the City of Orono. <br />PateSlBri. <br />ti^hlr********* *■ <br />CITY Staff recommendation: Approval <br />USE Reason for denial: — <br />ONLY City Council Action; Date___^Approved Deiued