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.r. <br />-i <br />"■;»■ • ^ <br />!•* <br />iV <br />Car,, <br />1^-. <br />r <br />,^>- <br />k V.; <br />fe'fi <br />tijf, <br />^V) ■ <br />v>..w <br />fk <br />yi"'- <br />ijf.'o. <br />M-' '■ ' <br />m¥- <br />CITY of ORONO <br />(612) 473-7357 <br />Post Office Box 66 <br />Crystal Bay, MN 55323 <br />SITE BVAI^DATOR/DESIGNER <br />LICENSE APPLICATION <br />All questions must be answered. License fee and evidence of MPCA <br />Certification must be attached. All applications are subject to a ten <br />(10) day approval period. <br />1. <br />2. <br />3. <br />4. <br />Business or trade name •.iPv <br />Business phone Residence phone_ _ _ _ _ _ _ <br />Neune of applicant or company representative(s) holding MPCA <br />certification *^Vs>/fra«^_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ <br />5. Type of certification held: ^____ Site evaluator <br />designer. Certificate expiration ______i - 3 ^ ~ <br />AC_ System <br />6.Have you ever performed site evaluation or design work in <br />Orono before? % Most recent year <br />7.Have you ever had a license revoked? VXAD <br />Where? <br />When? <br />i > / i/l U»\W1 <br />SUBMITTALS REQUIRED: <br />r_^jL. $100.00 License application fee. <br />\/ 2. Copy of current MPCA Certificate. £rt^ <br />i~ 1 i: \ AlriLt. u'/" I*” j-L E <br />f 7.11500000 <br />vi C-Ull iv'VkV'i <br />CHEL-u.- l-Z‘ Tti ' u Ai/U Ai\uuim.4.i I f I tm^n f uu <br />r.ViJ Titw' Lr\/\/A fill <br />^•i7/f • <br />1/i.V s ~ <br />55/r. <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED <br />Date <br />The undersigned hereby makes application to the City of Orono, <br />Minnesota, for a license to perform site evaluation and septic <br />system design subject to the laws of the State ot Minnesota and <br />the Ordinances of the City of Orono. <br />Applioanr's Signature <br />Staff recommendation Approval <br />Reason for denial: <br />Denial Date <br />City Council Action Date <br />Date license mailed <br />Aonroved Denied <br />—y r.r <br />U 1 ^ <br />,/ <br />» t ”73 f 12Lbi iLi L. vl:. L <br />WmR i 1 1992