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{■r- <br />et <br />w <br />u <br />1^fe" <br />-■f • ■.-ir-%- <br />t . <br />■-: <br />m- <br />ff. <br />r^- <br />.i#'Ss#' <br />P.,s-' <br /># <br />% <br />'v; <br />% <br />f,-' <br />^.v <br />s <br />K- <br />i; <br />I <br />#• <br />w <br />rt • <br />i-: <br />CITY of ORONO <br />(612) 473-7357 <br />Post Office Box 66 <br />Crystal Bay, MN 55323 <br />SEPTIC SYSTEM INSTALLERS <br />r LICENSE APPLICATION <br />L <br />/ <br />All questions must be answeo-'ed. License fee, bond , certificate of <br />ins'uAnce, and evidence of MPCA Certification maet lattaChed. All <br />applications are subject to a ten (10) day approvaT period. <br />1. <br />2. <br />4. <br />Business or trade name IVI (^Cdt-iy lOg^rH iOas'^ <br />UiA/u lD' Pla/?kPla^n /TIjO <br />Business phone Residence phone V*77~ ---- <br />Name of applicant or company representative holding MPCA <br />• Wy (YIC^^ __________certification hi <br />5.Type of certification held: <br />Certificate expiration date <br />Installer umoer <br />6. <br />7. <br />Have you ever held a Septic System Installer license in <br />Orono before? Most recent year /ff/ _ <br />Have you ever had a license revoked? t\.Q___ When?__________ <br />Where?________________________________________________________ <br />8. <br />9 <br />Do you do Municipal Sewer hook-ups? Yes <br />Do you pump out septic tanks? Yes X_ <br />No X <br />No ilTi OF ORQf^O <br />FIi\A^U OFFICE <br />SUBMITTALS REQUIRED; <br />/ . - 1. $50.00 License application fee. <br />1^2. $2000.00 license and permit bond naming City of Oron^ <br />obligee. The State Plumbers Bond will not be accepted <br />_■ i i tj V i.-v v V <br />A ^ rc\i <br />VJ. V?U1« <br />CA <br />W'V • w <br />ruci'x Ti C.A /V*/v* vv <br />l5i-fot3oS?OoS “ini;;irrer?iircatrcf^^^ <br />"7*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 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 <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 />Date <br />rJ'CITY <br />i USE <br />ONLY <br />Staff recommendation Approval <br />Reason for denial: _ _ ___ _ _ _ <br />Applicant's Signature a'^Ej-\ <br />_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _/- <br />Denial Date ^ <br />City Council Action Date <br />Date license mailed _ _ <br />Approved Denied