Laserfiche WebLink
• ' i ■ • <br />SEPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />CITY of ORONO <br />(612) 473-7357 <br />Post Office Box 66 <br />Crystal Bayr MN 55323 <br />All questions must be answer^d. License fee, bond, certificate of <br />insuAnce, and evidence of MPCA Certification must be attached. All <br />applications are subject to a ten (10) day approval pericj^g ^ ^ <br />j <br />>r . <br />s <br />'S»;- . <br />.■i <br />' <br />Rt-- <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />8 • <br />9. <br />Business or trade name Jt <br />Business address ^ ^^ ^ <br />Business phone Residence phone ^/7n <br />Name of applicant or company representative holding MPCA <br />certification jgSSi. ^ ^ <br />Installer PumperType of certification held: _ <br />Certificate expiration date __ <br />Have you ever held a Septic System Installer license in <br />Orono before? Most recent year 5*/ <br />jJS{{ave you ever had a license revoked? <br />Where? _________________________________—--------------- <br />Do you do Municipal Sewer hook-ups? Yes <br />Do you pump out septic tanks? Yes — <br />When? <br />No <br />r-TTv* r*r rorfkif)ui / r in ununu <br />I iitr^Muc. > iu-u, iltr?MU4- <br />13I1500000 <br />0l iES <br />rucrv 1 <br />50, OC <br />50. OC <br />SUBMITTALS REQUIRED <br />4 <br />uECEIPT-T^n^K YOU <br />ii2356S0 cool ROi Ti2‘, <br />0Z^24/ <br />$50.00 License application fee. nr-r^nr <br />$2000 00 license and permit bond naming City o <br />obligee. The State Plumbers Bond will not be accepted^ <br />$50-100-300,000 minimum Certificate of Insurance. <br />_ _ ‘ 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 />The undersigned hereby makes application to the City <br />MiLesota, for a license to install Stlt^of <br />and/or pump out septic tanks, subject to the la <br />Minnesota and the Ordinances of the Ciyy^ of Orono, <br />Date ^ ^ Applicant’s Signature <br />CITY <br />USE <br />ONLY <br />Staff recommendation Approval <br />Reason for denial: <br />City Council Action Date <br />Date license mailed _ _ _ <br />Approved Denied <br />i--.