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ft.■,p v/« •CITY of ORONO <br />(612) 473-7357 <br />Post office 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 Certification must be attached. All <br />applications are subject to a ten (10) day approval period. <br />: I Business or trade name ^ ^/f <br />2. <br />3.Business phone ^ ^^ Residence phone vJ-* <br />4. <br />5. <br />/ <br />Type of certification held: <br />Certificate expiration date <br />Installer Pumoe <br />o • <br />%■ <br />\ <br />i ■, <br />7. <br />1.. <br />Have you ever held a Septic System In^^l <br />Orono before? J Most recent year /* * f <br />When? <br />ler license in <br />Have you ever had a license revoked? <br />Where? __________________________r T f <br />L 1 li Ut U’l^U'lTU <br />'rl <br />9. <br />Do you do Municipal Sewer hook-ups? Yes <br />Do you pump out septic tanks? Yes _ _ _ __ No <br />No <br />cV A/AAi“C ricir T <br />t VI I i. Uri- <br />UZi 7 <br />A 9JX X i./ V'W W <br />fM rrv ’^’^.00LJ <br />rum' <br />u > li-vn <br />Tl <br />I 1-A. te,* • vv <br />vna <br />SUBMITTALS REQUIRED: <br />f\C,LCir i 11 I <br />;i225340 COOl RCi 715:41 <br />02/1S/9..ni <br />ir^l, $50.00 License application fee. <br />2. $2000.00 license and permit bond naming City of Orono as <br />obligee. The State Plumbers Bond will not be accepted <br />HT-.. <br />obligee* The State Piumhers hona wixx noi: oe <br />yT\2, $50-100-300,000 minimum Certificate of Insurance. <br />4 . Copy of current MPCA Certificate. <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED <br />List persons other than applicant who ■ <br />for permits under your license <br />.ithorized by you to apply <br />Ef-, <br />The undersigned hereby makes application to the City of Orono, <br />Minnesota, for a iicf.nse to install and repair septic systems, <br />and/or pump out septic tanks, subject to the^aws of the State of <br />Minnesota and the Ordinances of the City oSrOrono. <br />Date ^ Applicant's Signature^' <br />W"y <br />:ty <br />E <br />ILY <br />Staff recommendation Approval <br />Reason for denial: <br />Denial Date <br />City Council Action Date <br />Date license mailed <br />Approved Denied <br />V*/ . ' <br />, ,1, Y.,,, <br />iPV--ii ..Atiillfifco.