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CITY of OKONO <br />(612) 473-7357 <br />Post Office Box 66 <br />Crystal Bay^ MN 55323 <br />SEPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />All questions must be answered. License fee, bond, certificate of <br />insurance, and evidence of MPCA Certification must be attached. All <br />applications are subject to a ten (10) day approval period. <br />1. <br />2. <br />3. <br />Business or trade name f C- <br />Business address JoCY. ^~QS <br />^ / <br />Business phone V 7 7- "SO 77^ Residence phone ^ ~77~ 5 7 <br />4. Name of applicant ar company representative holding MPCA <br />certification ----*______________________________ <br />5. <br />6. <br />7. <br />Type of certification held: Installer <br />Certificate expiration date <br />Pumper <br />Have you ever held a Septic System Installer license AfYv r,c rrjnun <br />^------------------.. iX Most recent year ^ 21 __ ' '''Orono before? <br />Have you ever had a license revolced? <br />Where? <br />\J O V?hen? <br />f7.V/)Afif CfF/Cfiznzoom <br />m C£H 5Q.0C <br />8. Do you do Municipal Sewer hook-ups? Yes <br />9. Do you pump out septic tanks? Yes _ _ _ <br />No <br />SUBMITTALS REQUIRED: <br />^ 2. <br />L<^3. <br />4. <br />$50.00 License application fee. <br />$2000.00 license and permit bond naming City of Orono as . <br />obligee. The State Plumbers Bond will not be accepted <br />$50-100-300,000 minimum Certificate of Insurance <br />Copy of current MPCA Certificate. ' <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITQ!S ARE SUBMITTED <br />List persons other than applicant who are authorized by you to apply <br />for permits under your license ________________________________________________ <br />The undersigned hereby makes application to the City of Orono, <br />Minnesota, for a license to install and repair septic systems, <br />and/or pump out septic tanks, subject to the laws of the State of <br />Minnesota and the Ordinances of the Cityj of Orono. <br />Date /O ' y I " 3 Applicant's Signature ____ <br />CITY <br />USE <br />ONLY <br />Staff recommendation Approval <br />Reason for denial: <br />Denial Date <br />City Council Action Date <br />Date license mailed <br />Approved Denied