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X <br />CITY of ORONO <br />(612) 473-7357 <br />f. Post Office Box 66 <br />J Crystal Bay, MN 55323 <br />SEPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />All questions must be answered. License fee, bond, <br />inauAnce, and evidence of MPCA Certification must be ^tach d. All <br />applications are subject to a ten (10) day approvalpgar:2><C. 1.— <br />'f;; <br />1. Business or trade name <br />___ ri <br />Tn C PrAjD^v' I t rvHi ^ <br />T ^ “ vj ' <br />* <br />2. <br />3. <br />4. <br />Business address PA i -v \\m I ^ l< <>- .L <br />Business phone _ Residence phone ----------------- <br />I <br />f::' <br />Name of applicant or company representative holding MPCA <br />certification r~>o p or\-g p“lit a ---------------—--------—------- <br />5. <br />'K^ipfe«- <br />Type of certification held: <br />Certificate expiration date <br />y Installer Pumper <br />\q^ <br />VvW <br />ti?:7 . <br />, r <br />Have you ever held a Septic System ^staller license i <br />Orono before? Most recent year /J_J---- <br />Have you ever had a license revoked? I\]Q----- When? -------------- <br />Where? <br />8.Do you do Municipal Sewer hook-ups? Yes <br />Do you pump out septic tanks? Yes - -- <br />V <br />No <br />No <br />V <br />{“ T V r'tiT !ah t <br />^ S I I t-'f <br />Flr^AtiCE OFFICE <br />1111500000 <br />At I CXj\/a c?ui« <br />i UL! K <br />u I U-Up 71 <br />-c: Ar<W <br />•iC <br /><. w' • V V <br />RECEIPTrCU -'^-^0 cool ROl TIO:SOBMITTALS REQUIRED: ^21^ <br />'/>1. f$50T00> License application <br />7^2, SwmfToO license and permit <br />^^2**4 . Copy of current MPCA Certificate <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL I TEMS ARE SUBMITTED <br />List persons other than applicant who are au^orized by you to apply <br />for permits under your license y < <-c/ a?A? '-'Aizd- <br />S5nnAotnnrthroALancfs^f “Vhe''c <br />Date Applicant's Signature / <br />;iTY <br />rsE <br />>NLY <br />Staff recommendation Approv <br />Reason for denial: _ _ _ _ _ _ <br />City Council Action Date _ <br />Date license mailed _ _ _ _ _ _ <br />Denial Date <br />Aooroved*• <br />Denied