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m-- <br />w. <br />■ki:m- <br />IP <br />r <br />'t' <br />b'W- <br />:%.I'^i:> <br />S- <br />■I <br />.•# <br />;C. <br />- ' } >'• <br />^ -'Vi <br />¥1'. <br />• ■/ m^r. <br />■[• . <br />CITY of ORONO <br />(612) 473-7357 <br />PoS't Office Box 66 <br />Crystal Bay, MN 55323 <br />SITE BVALDATOR/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 />Business or trade name ^ <br />Business address ^, /yl/AjAJ, ^ y <br />Business phone ^79 - 3* 7 Residence phone ^7^--o7<^3 7 <br />4.Name of applicantcompany representative(s ) holding MPCA <br />certification A /g r' A ji. /? ^*^ >€. V o r /V <br />5. Type of certification held: <br />designer. Certificate expirat <br />Y Site evaluator V System <br />, /7- ?/ - <br />6.Have you ever performed site evalna-i-ion or design work in <br />Orono before? y^S Most recent year // <br />7.Have you ever had a license revoked? When? <br />Where? _ _ _ _ _ _ _ <br />,,i:7 <br />SUBMITTALS REQUIBED:tin Of o^m <br />a. •$100.00 License application fee. <br />2. Copy of current MPCA Certificate. <br />r"-Ji:Mrr ~.cv~~z <br />I C’l I A Ut- <br />♦ T ^ ^ f )| \i)/ > <br />J, ..‘I A w'V V VV V <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARP SUBMlT^Efo <br />01 QEri i.W« \ <br />Vu iA vv» J» V <br />DrrrTOT-ruAi/V ynn <br />i\uLuli t I \JU <br />?ne undersianed hereby makes application to the City#bSu!<>rib-tfi) <br />>7/alnation and septic OJ/i.Minnesota, for a license to perform site e <br />system design subject to the laws cf the State of Minnesota and <br />the Ordinances of the City of Orono. <br />Date -J3 ~ y / ~ ^ ^Applicant's Signature . rcol <br />Staff recommendation Approval <br />Reason for denial: _ _ _ _ _ _ <br />Denial Date <br />City Council Action Date <br />Date license mailed <br />Approved Denied <br />.S.i.