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1n ■■■ :.j <br />k: <br />CITY of OKON <br />- (612) 473-7357 <br />SEPTIC. SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />%i <br />Post Office Box 66 <br />|f" Crystal Bay, MN 55323 oo'> <br />i- <br />CA"'S: <br />p <br />All questions must be answered. License f‘certificate of <br />insurance, and evidence of MPCA Certification must be -Beached. All <br />applications are subject to a ten (10) day approval period. <br />1 “ <br />‘M <br />1. <br />2. <br />3. <br />4. <br />Business or trade name <br />Sons Jr y.Ca.Oo.Pi <br />Business sddress j/YlonPr/nS €, <br />Business phone ^'7 ^ “ 3 b A ! Residence phone ____________ <br />-O-r <br />tz5. <br />Name of applic^t or company representative holding MPCAName of applic^t or company represent <br />certification HcL^-^S ^ ^I <br />J4 <br />Type of certification held: X Installer <br />Certificate expiration date /9-/ <br />Pumper tl <br />‘IS <br />“TTV i-.r nor^ifi <br />. - . C-s M c'l W»'UMUHave you ever held a Septic System Installer 11cense <br />Orono before? yd 5 Most recent year _ _ _ _ 131150^^ <br />0 <br />ir <br />I* <br />.t: <br />7s Have you evei. had a license revoked? <br />Where? __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ <br />A/O When? <br />r» i rcki <br />V .1 U*i-i t <br />-1^ rw) <br />U I (C u #) <br />i r I u <br />r,'i M <br />YOUw%. <br />3:- <br />9. <br />Do you do Municipal Sewer hook-ups? Yes <br />Do you pump out septic tanks? Yes _ _ _ <br />No <br />I ii I * f I ? t^t t i I i ^ Arrfc, c V «' V' u V A n V A i w * UiJ <br />---- -7 V*j/vO <br />No <br />SUBMITTALS REQUIRED: <br />[/' 1. $50.00 License application fee. ^ <br />$2000.00 license and permit bond naming City of Orono asP^ <br />C4--«4-a W7 1 1 not* be ^CCeOtGCJ • <br />2. <br />■Jf- <br />obligee. The State Plumbers Bond will not be accepted.^^ <br />3. $50-100-300,000 minimum Certificate of Insuranc^e.Sj^ <br />T7 4. Coov of current MPCA Certificate. ^ <br />^ l?r3hJf ZY3 • <br />) UNTIL ALL ITEMS ARE SUBMITTEDLICENSES WILL NOT BE PROCESSE <br />List persons other than applicant who are authorized by apply <br />for permits under your license <br />■ <br />The undersigned hereby makes application to the City of Orono, <br />Minnesota, for a license uo install and repair septic systems, <br />and/or pump out septic tanks, subject to the laws of the State of <br />Minnesota and the Ordinances of the City of Orono. <br />fv <br />p ft <br />Date 3 " ^ '2^Applicant's Signature C^ <br />CITY <br />USE <br />ONLY <br />Staff recommendation Approval <br />Reason for denial; _ _ _ _ _ _ _ _ _ _ <br />City Council Action Date _ _ _ _ <br />Date license mailed _ _ _ _ _ _ _ _ <br />Denial Date <br />Approved Denied <br />'W.-