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ch-vofo«<.No <br />, <^”37 ' SEPTIC SYSTEM INSTAIiLEES <br />LICENSE APPLICATION(612) 473-7357 <br />Post Office Box 66 <br />Crystal Bay» MN 55323 <br />J <br />L ■'7 33 <br />A1 1 nuGstions must be answered. License fee, bond, certificate of <br />1. <br />•7 • <br />3. <br />4H • <br />5. <br />6. <br />7. <br />Business or <br />Business address <br />tra'®'’ name ^ A'l >‘^^0 r 3 rt- <br /><r ■Business phone Residence phone <br />Name of apolicant or company reore_sentative holding .'!JCA <br />certification -To,.. *-T:^ ■•'OO’-’' — <br />Type of certification held; <br />Certificate expiration date <br />Installer Pumoer <br />~72T /:?// ■?!> <br />Have you ever hel^^a Septic System installer license r*. <br />Orono before? Most recent year / . <br />Have you ever had a license revoked? A^O ._ ^'^hen? <br />Where? <br />8. Do you do Municipal Sewer hook-ups? Yes <br />9, Do you pump out septic tanks? Yes - --No <br />SUBMITTALS REQUIRED: <br />r I^Si0?00^\“\%l'=iidTr-i3ro;d naaang City of 0r<^ ^ <br />obligee. The State Plumbers Bond will not be acs_^ted.£'/r> <br />\y $50-100-300,000 minimum Certificate of xnsu ranc Q. <br />Copy of current MPCA Certificate. <br />LICENSES WII.L NOT BE PHOCESSED UNTIL ALL ITf>1S ARE SUBMITTED <br />List persons other than applicant who are authorize^ be^you to appl^ <br />for permits under your license J) --------{■ ' <br />The undersianed hereby makes application to <br />Minnesota, for a license to install =73.1^ Vtatrof <br />and/or pump out septic tanks, subject to <br />Minnesota and the Ordinances of the Ci^y^^ ■'•'^7 <br />. /• • <br />Date <br />CITY <br />USE <br />ONLY <br />3 Applicant's Signature <br />Staff recommendation Approval <br />Reason for denial; _ ___ _ _ _ <br />Denial Date <br />City Council Action Date <br />Date license mailed _ _ _ <br />Approved Denied