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CITY of ORONO <br />(612) 473-7357 <br />Post Office Box 66 <br />Crystal Bay^ MN 55323 <br />SEPTIC SYSTEM INSTAIXSPS <br />LICENSE APPLICATION <br />All cuestions must be answered. License fee, bond, certificate or <br />insurance, and evidence of MPCA Certification must be attacne*.. All <br />applications are subject to a ten (10) day approval period. <br />^ C) <br />1. <br />2. <br />3. <br />Business or trade name <br />Business address <br />Business phone ^ ^Residence phone /_—^ <br />Name of applicant <br />certification <br />■ comoany representative holding MPCA <br />Tv ’pe of certification held: — Pumper <br />Certificate expiration date r — ' ^ Lf <br />Have vou ever held a Septic System Ipsta 1 ler license in <br />Orono before? ^ Most recent year <br />Have you ever had a license revoked?When? <br />Where?______________________________—--------------------------------- <br />8 <br />9 <br />DO you do Municipal Sewer hcok-ups? Yes - No <br />Do you pump out septic tanks? Yes - - - - No f 7f f ^Afsrsrsi\ <br />1 WAAte^WWV <br />n i rrv r,-» /V <br />rucri^ <br />c. I <br />Tft u <br />SUBMITTALS REQUIRED <br />W*i1l */*• wTV <br />RECEIPT-THAfiK YOUacBtsio cool ROi riii <br />. ' '*'' ^ 4/yf 1. ^$50.00 Licen'-;e aoplication fee. “"•* <br />ikr 2. v/$2000.00 lice.-pe and permit bond namxng City of Orono ^ ^ <br />’ /jbligee. The State Plumbers Bond will not be accrued.trifpi V- O . <br />X 3. *'$50-100-300,000 minimum Certificate of Insurance <br />'^ 4. ^Copy of current MPCA Certificate. <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED <br />.... ..... ■!!!! <br />and/or pump out septic tanks, subject to the laws of e <br />Date <br />City Q^-Orono. <br />CITY <br />USE <br />ONLY <br />Staff recommendation Approval <br />Reason for denial: <br />w Denial Date im±3^ <br />City Council Action Date <br />Date license mailed __ _ _ <br />Approved Denied _