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CITY 6f(612) 47:OKONO“7 157 <br />Post 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 />evidence of MPCA Certification must bi attathel All <br />applications are subject to a ten (10) day approval period. <br />1. <br />2. <br />3. <br />4. <br />Business or trade name <br />Business address . .. o, g, /r _ _ _ _ _ <br />Business phone fr~/S' /_ _ Residence phone ^^ ^ ^ H ^ C) <br />5.Type of certification heldf^Py j Install <br />MPCA <br />Certificate expiration date Pumper cm OF uRm <br />FI/lA/fCE OFFICE <br />8. <br />9. <br />„ t InntiLi <br />Have you ever held a Septic System^nsta 1 ler liceni^il^>000 <br />Orono before?, Most recent year p 01 C£V 50,C\ <br />„ [7 . . CHECK 71 50 Oi <br />Have you ever had a license revolted? yy ^ When? RECEIPTYiHl <br />-------------------------------------------------------------------------------------^^265370 COO! ROt TIE- <br />%/im/ i^./Do you do Municipal Sewer hook-ups? Yes No <br />Do you pump out septic tanks? Yes X No <br />SUBMITTALS REQUIRED: <br />K. 1- <br />•V^2. <br />$50.00 License application fee. . <br />$2000.00 license and permit bond naming City of Orono as <br />The State Plumbers Bond will not be accepted. <br />550—100—300,000 minimum Certificate of Insurance. H*., <br />Copy of current MPCA Certificate. ^ <br />-V 3. <br />^4. <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITQIS ARE SUBMITTED <br />List persons other than applic. <br />for permits under your license <br />re authorized by you t<T~ap ply <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 City of Orono. <br />X/Xll Applicant * s Signature <br />CITY <br />USE <br />ONLY <br />Staff recommendation Approval <br />Reason for denial: <br />enial Date <br />City Council Action Date <br />Date license mailed <br />Approved Denied