Laserfiche WebLink
CITY of OUONO W f <br />SEPTIC SYSTEM INSTALLERS <br />•’license application <br />(612) 473-7357 <br />Post Office Box 66 <br />Crystal Bayt MN 55323 <br />,,, ___ answered. lAftffensa bond, certificate of <br />Jnsur^nce =nd eTidtncI of MPCA Cer’?mca?iojvj,ust be attached. All <br />apllications are subject to a ten (lOPTlay approval period. <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />IV\Orv\p^nn~Plurn\Qi r^Cx>r.p . <br />\ I \ M t\ X 1 \ <br />Business or trade name <br />Business address \^00\ <br />Business phone 1 Residence phone <br />Name of applicant or company representative holding MPCA <br />certification ' Vc c: i <br />Type of certification held: X <br />Certificate expiration date <br />Installer Pumper <br />Have you ever held a Septic System Installer license in <br />Orono before? IIC^ Most recent year JjlL---- <br />Have you ever had a license revoked? <br />Where? <br />Do you do Municipal Sewer hook-ups? Yes <br />Do you pump out septic tanks? Yes -- - -- No <br />When? <br />CITY OF fiROHQ <br />FimCE OFFICE <br />submittals REQUIRED: <br />(jToT^ <br />OJ CEH <br />CHECK TL <br />50. i <br />RECEIFT-THm YW <br />3. $'»:4oO-300,000 minimum Certifies^ of In^rance. <br />cy 4. Copy of current MPCA Certificate. ^Cp, )^-6rT3 <br />licenses will not be processed until all items ABE SDBMITTED <br />^^t persons other than applio^ant vho are authorized by <br />for permits under your i ^ oense ^.n Flanut<»^, CJnri^ CJL<Qr>iiji.i taO ttih , <br />G jo .iaS.C.'* 3bor>*''<- C/^ <br />The undersigned hereby s,ake» <br />Minnesota, for a license to instil "Pfj-JgState of <br />and/or pump out septic tanker subject to <br />Minnesota and the Ordinances of the City^^^^ ^ <br />Date Applicant*8 Signature^Q <br />Reason for denial: <br />late <br />City Council Action Date <br />Date license mailed <br />Approved Denied