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€lTYof OUONO 1 SEPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION(612) 473-7357 <br />Post Office Box 66 <br />Crystal Bayr MN 55323 <br />All questions must be answere^X^Licfe^S^iee, 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 />4. <br />C • <br />6. <br />7. <br />8. <br />9. <br />Business or trade name ^\X) A-^ ) SJ- -- <br />Business address Vt Q'lOvC I? —SS33_0 <br />Business phone Residence phone ------------ <br />Name of applicant or company representative holding MPCA <br />certification A/ltr^liA) Al/n v\ iSfii a1----------------------- <br />InstallerType of certification held: <br />Certificate expiration date <br />Have you ever held a Septic System <br />Orono before? V(f.$ Most recent year <br />y Pumper <br />Have you ever had a license revoked? <br />Where? _ _ _ _ _ _ _ _ _ _ _ ___ _ _ _ _ _ _ _ _ <br />er license in <br />When? <br />Do you do Municipal Sewer hook-ups? Yes <br />Do you pump out septic tanks? Yes _ <br />No y <br />cm OF orm <br />SUBMITTALS REQUIRED: <br />X 1. $50.00 License application fee.■"- - -- -■•-I- - - - - - -—s KonH naming Cityr< <br />FIHAHCE OFFICE <br />1311500000 <br />01 CEN 50.00 <br />2: ”000^00 W be accepwifeya mi <br />3. $50-100-300,000 minimum Certificate of Insurance.^q2/Z6- <br />' 4, Copy of current MPCA Certificate. ' <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED <br />List persons other than applicant <br />for permits under your license /VIA—- - - --— ~ “ <br />The undersigned hereby makes application to the <br />Minnesota, for a license to install and repair ®®P st^te of <br />and/or pump out septic tanks, subject to the laws o <br />Minnesota and the Ordinances of the City of Orono. <br />Date 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