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CITY" of OKONO <br />SEPTIC SYSTEM INSTALLERS <br />application <br />(612) 473-7357 <br />Post Orfice Bex 66 <br />Crystal Bay# MN 55323 <br />All questions must be ?tr;che “'\r! <br />iSriicaficnrl^l's^b jlSt t'o "■ ten (l5)-d-ay eporov. 1 period. <br />1. Business or tra^e nair.e Volkenant Inc <br />2. Business address 1030 Countv Rd 83 Manle Plain Mn 5 3339_ <br />3. <br />4. <br />5. <br />Business phone ^79-1517____ .Residence phone <br />Name of applicant or company representative holdinj MPCA <br />certification T^nn V'olkenant. <br />Installer X Pumper <br />71 nor 1003 <br />Tvoe of certification held: <br />Certificate expiration date <br />Ha"“ vou ever held a Settle System Installer license *0; fir i«&' <br />Orono before? Yes _ Most'recent year _1022_ <br />Have you ever had a license revoked? -sin When? <br />Where? _ _ <br />8 <br />9 <br />11I k. <br />r:.--* r*w'k' • V <br />« Vv <br />Do you do Municipal Sewer hook-ups; /e. <br />Do you pump cut oeptic tanks? Ye.t -- - No <br />l'l rr“DT,.rumr vnt tIsuLLa* f * nnt\f \ »Lfu <br />^ * T* f' ! <br />U’ W* A «1 V <br />.'tT/fVt.^/ X X <br />SUBMITTALS REQUIRED: <br />■PKID <br />* / <br />c • <br />naming City of Orono ^ <br />11 'not be acceptednh^ioee. The State riumoeri oouu -ij.4. -- - - - -^ <br />y $50-100-300,000 ninimun Certificate of Insurance, <br />Copy of current MPCA Certificate. <br />licenses will not be processed until au, items are submitted <br />List persons other than applicant who are aut.horized by you to apply <br />for permits under your license - - - --- - - - - - - - --- - - - - - - -- ~ <br />The undersicned hereby makes application to the <br />Minnesota, for . license to install Stlte'of <br />and/or piimD out septic tankSf subject to the 1 <br />Minnesota and the Ordinances of the City or Orono. <br />Date ^ ~ ^AoDlicant s Signature ■ u^ «» <br />r> —'"V <br />USE <br />ONLY <br />Staff recommendation Atoreval denial <br />Reason for denial: _ _ _ _ _ _ _ _ _ _ <br />City Council Action Date _ _ _ _ <br />Date license mailed __ _ _ _ _ _ _ _ <br />Date i '“/S' <br />.Approved Denied