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CITY of ORONO * <br />(612) 473-7357 <br />Post Office Box 66 <br />Crystal Bay, MN 55323 <br />SEPTIC SYSTEM INSTALLERS <br />LICEJJSE APPLICATION <br />All Questions must be answered. License fee, bond, certificate o. <br />and evidence of MprA Certification tist be attacnec. All <br />Spolicalions are subject to a ten (10) day appr- al period. <br />1. Business or trade name <br />y, . <br />o <br />4m • <br />-- - - - - - - - - - - - —iZ—:—* - - - — , ^ <br />Business address ^ . r- <br />3. <br />4. <br />Business phone Res-i:dence phone <br />Name of applicant or ccm^any.^resen^ative holding MPCA <br />5.Type of certification held: <br />Certificate expiration date <br />X! Installer Punoer <br />6.Have vou ever held a Septic System Installer license in <br />Orcno before? I/a J .Most recent year J_j_ <br />7.Have you ever had a license revoked? <br />Where? - - - - - - - - - --- - - - --- - --- - - - <br />When? <br />8 . <br />9. <br />Do you do Municipal Sewer hook-ups? Yes <br />Do vou pump out septic tanks? .iTes -- - <br />X <br />No <br />No <br />X <br />il’i OF Ol^O^C <br />-TUiM-^rr "TTrc <br />i mt < 1 'U <br />?■ 7f f WWV <br />50. OC,'t i rrj* <br />wv*%/v <br />SUBMITTALS REQUIRED: <br />V-* J. VUi <br />u-i7C t i ^ <br />il^iTrLTO T*— 7 y iI t nniut I i.'U <br />t M / \>‘ A nV'A IV//* <br />AT/AO; <br />✓ Vw‘/ V// <br />i<\. $50.00 License application fee. ^ _ ,^,4.., ,.fr orono as <br />~/^2. S2C00.00 license and permit J ac-^ot^d. <br />y 3. SfO-foollOO.OOO mini:au.. Certif icat^ of ^surance. £-/p. SW <br />"P'4. Copy of current MPCA Certificate.^^- <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED <br />List persons other than applicant who are authorized by you to a.p y <br />for permits under your license yy? <br />The undersigned hereby makes application ^"^/^^Xstems! <br />Minnesota, for a license to rhi^aws o? the S«te of <br />and/or pump out septic tanks, subject to the law^ <br />Minnesota and the Ordinances of the oiwV ^ <br />Date ;/?//Applicant's Signature <br />I T <br />M ^ A <br />USE <br />ONLY <br />Staff recommendation Approval <br />Reason for denial: <br />City Council Action Date <br />Date license mailed <br />Date <br />Denied <br />‘101