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CITY of OKONO(612) 473-7357 <br />Post Office Box 66 <br />Crystal Bay^ MN 55323 <br />%TIC SYSTEM INSTALLER. LICENSE APPLICATION <br />< . <br />All questions must bo answered. ^ <br />1. <br />2. <br />3. <br />4 . <br />Business or trade name Vi/idnier Inc. <br />Business address P.O. Box 219» St. Bonifacius. i-lN 55375 <br />Business phone 612-446-1495 Residence phone <br />Marne of applicant or company representative holding MPCA <br />certification Anthony Vancferlinde_________________________________ <br />5.Type of certification held: <br />Certificate expiration date <br />X Installer Pumper <br />6.Have you ever held a Septic System Installer license in <br />Orono before? Most recent year — <br />7.Have you ever had a license revoked? <br />Where? _ _ _ _ _ _ _ _ _ ___ _ _ _ _ _ _ _ _ _ <br />No When?CIT'f 0*^ DfiQtiQ <br />nrniiCE OFFICE <br />15U5C0000 <br />8. <br />9. <br />Do you do Municipal Sewer hook-ups? Yes <br />Do you pump out septic tanks? Yes - - - <br />01 <br />ttiCK TL <br />CTA A <br />w'Viw*V« V k <br />50 s C <br />No imiPT-wm YOU <br />H266630 coot ROl T13 <br />--------------------03/Qi <br />SUBMITTALS REQUIRED: <br />y 1. <br />IHiurIn«X -;.Jkne bcaue rxiuuuci-—- -— - , <br />$50-100-300,000 minimum Certificate of Insurance.^ <br />rent MPCA Certificate. •Copy of current <br />LICENSES WILL NOT BE PROCESJiED UNTIL ALL ITEMS ARE SUBMITTED <br />List persons other than applicant who are authorized by you to apply <br />for permits under your license ^ - -—- - - - - --- - - <br />Date <br />ri^n^es^tV^’o^^'^a \Y=\\’^s:\^o in^aVr <br />rifnrso?nnrthrrr^atnrnfel^rVhrcit}^0« <br />c__2) ^2-26-93 Applicant's Signature <br />staff recommendation Approval <br />Reason for denial: __ _ _ _ _ _ _ <br />City Council Action Date _ _ <br />Date license mailed _ _ _— <br />Denial Date <br />Approved Denied <br />J