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p•1 r <br />i;f <br />r <br />fe; <br />P <br />•>' <br />r»f“ <br />r-v <br />“?i- <br />sr , <br />■' ■■KLm <br />' „ V <br />-Vr.!v <br />:vi;y <br />Nv' <br />:-rm <br />IS-# <br />:l®'- <br />• • •CITYof OKONO <br />(612) 473-7357 <br />Post Office Box 66 <br />Crystal Bay, MN 55323 <br />SEPTIC SYSTEM INSTALLBP <br />LICENSE APPLICATION <br />All questions must be answered. License feer bond, certificate of <br />Insurance, and evidence of MPCA Certification must be attached. All <br />applications are subject to a ten (10) day approval period. <br />1. <br />2. <br />3. <br />4. <br />Business or trade name <br />Business address ^'7 S f <br />Business phone ^^9— q/qo^ Residence phone — <br />Name of applicant or company representative holding MPCA <br />certification O a w i ^ 7 ? \ [_____ <br />5.Type of certification held: <br />Certificate expiration date <br />I n s t a 11 e r Pumpercm OF uRDHO <br />FJ^m^ OFFICE <br />6.Have you ever held a Septic System Installer 1 iceiisy^^^^^^j^ <br />Orono before?Most recent year *7 j / VZTk'fi-wA <br />7.Have you ever had a license revoked? <br />Where? <br />When? <br />5<?. <br />TL oOt <br />hliEiPT-THM YDL <br />H24i630 COOl ROl U <br />---------- 05/1 <br />8. <br />9. <br />Do you do Municipal Sewer hook-ups? Yes No <br />Do you pump out septic tanks? Yes No <br />SUBMITTALS REQUIRED: <br />Z! 2. <br />$50.or License application fee. ^p. <br />$2000 JO license and permit bond naming City of Orono asS^p^^ <br />obligee. The State Plumbers fond will not be accepted. <br />$50-100-300,000 minimum Certificate of Insurance^^.ji?-^^ <br />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 'T)/aw^<r s______________________ <br />The undersigned hereby makes application to the City of Orono, <br />Minnesota, for a license to Install and repair septic systems, <br />and/or pump out septic tanks, subject to the laws of the State of <br />Minnesota and the Ordinances of the Cirty^of Orono. <br />Date <br />CITY <br />USE <br />t:?LY <br />^ A- ^ Applicant's Signatur <br />i Cirfcyt of Orono. <br />Staff recommendation Approval <br />Reason for denial: <br />Denial 5'~SO-9^ <br />City Council Action Date <br />Date license mailed <br />Approved Denied <br />*5