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Cl l/l i>f OUONO <br />(6121 4<73-7357 <br />Post '^t‘fice Box 66 <br />Crystal Bay, MN 55323 <br />SEPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />All questions must be answered. License fee, -bond, certificate of <br />insurance, and evidence of MPCA CertKiMbatibn ‘must be attached. All <br />applications are subject to a ten (10) day approval period. <br />1. <br />2. <br />3. <br />4. <br />Business or trade name ^ ^^ ^^ <20- U<Z 7^) <br />Business address ^ (o 3 S ^'n SS'JLB <br />Business phone jiWiF Residence phone ^ ~ 3^ / <br />Name of applicant or company representative holding MPCA <br />certification C ^9V) <br />5.Type of certification held; <br />Certificate expiration date <br />X Installer Pumper <br />6. <br />7. <br />Have you ever held a Septic System Installer license in <br />Orono before? Most recent year /9 9 <br />Have you ever had a license revoked? When? __________ <br />Where? _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ <br />8 . <br />9. <br />Do you do Municipal Sewer hook-ups? Yes <br />Do you pump out septic tanks? Yes _ _ _ <br />No JL/O <br />CITY OF OROh‘0 <br />FIRARCE OFFICE <br />'‘11500000 <br />01 SP? 50.00 <br />4 o <br />CHECK Ti 50.00 <br />hECEIFT-rfm YOU <br />M266H40 cool <br />$2000.00 license'and permit bond naming City of Orono <br />obligee. The State Plumbers Bond will not be accepted. <br />3. $50-100-300,000 minimum Certificate of Insurance. <br />3:^ <br />SUBMITTALS REQUIRED: <br />y/^. $50.00 License application fee. <br />LICENSES <br />A Certificate. <br />OCESSBD UNTIL ALL ITEMST ARB SUBMITTED <br />List persons otter than appiicar^ who are authorized by you to apply <br />for permits under your license _ _ _ _ _ _ __ <br />The undersigned hereby makes application to the City of Orono, <br />Minnesota, for a license to install and repair septic systems, <br />and/or pump out septic tanks, subject to the laws of the State cf <br />Minnesota and the Ordinances of the City of Orono. <br />Date - 3 — 9 3 Applicant's Sicjiature <br />CITY <br />USB <br />ONLY <br />Staff recommendation Approval <br />Reason for denial: _ _ _ _ _ _ _ _ <br />City Council Action <br />Date license mailed <br />Ttl Denial Date <br />Date Approved Denied