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■#i.Foal 'juice ooA oo <br />axYo <br />c^: <br />'•>•- <br />i' <br />U' <br />£ <br />f- <br />; <br />fl,(-:A- <br />V' <br />.,>v <br />» <br />V-. <br />’5- <br />V=’ <br />1-5 * <br />- <br />if <br />f--: ■ <br />li?' <br />K. <br />■? • <br />.r <br />teli8iiW.lnii^fc^ <br />Cryital Bay» BiinneMUi 55323 SEPTIC SYSTEM INSTALLERS <br />-LICENSE APPLICATION <br />BUILDLNC A ZONING - 473-7357 <br />assessing <br />All questions iJUlSt be answered. License fee, bond, certificate <br />Mjpfanci, 1*05 evidence of MPCA Certification or Horae Sewage <br />Treatment Workshop attendance must accompany this application. <br />« t “ . . _______ ________%•_____|_ J__________ / -1 n \ J-,., ^ 1All applications are subject to a ten (10) day approval period. <br />1. Business or trade name ^E' ^ JlA A~ N /0*-S> <br />2. <br />3. <br />Business address OB' U {1(\}^C,lU([/ <br />I I ( / — -5^330Business phone ^I3t- V«b Residence phone e^UViO-, <br />Name of applicant or company representative holding MPCA <br />certification _______________________ <br />Installer X PumperType of certification held: ____ <br />_____ Site evaluator ____System designer . <br />Is this a Provisional Certificate? (\fO Certificate No. /.^&/ <br />'lAVl <br />FIC£ <br />8. <br />d. <br />If no Certificate is held, provide evidence of attendance at <br />one of the On-Site Sewage Treatment Workshops hej.d imme^^l^tj^\ <br />prior to the current construction se^on. * <br />Have you ever held a Septic System ^noteal^er license^^h^^^j <br />Orono before? KT/3 Most recent year _ _ _ _ Cl^CK TL <br />, ^ liECEm-rnm yol <br />Have you ever had a license revoked? J^O When? HI'40990 COOl iOl T. <br />Where? <br />Do you do Municipal Sewer hook-ups? Yes_ _ <br />10. bo you pump out septic tanks? Yes X No <br />No kG:) <br />05/( <br />\jQe do JlA36-lal( S€ m'OSUBMITTALS REQUIP.ED: ____. /^.oo ------- rmSCE OFFICE <br />1/^ 1. license application fee. 13llt00000 <br />2. $2000.00 license and permit bond naming City of Orono <br />obligee. The State Plumbers Bond will not be iPT-lim YCiiX 3. $10-50-100,000 minimum Certificate of Insurance.-ry:vr;^) li <br />X 4. Copy of current MPCA Certificate or evidence of atten^Kcfi Ac/'i <br />ilyat On-Site Sewage Treatment Workshop [j.eld immediately <br />prior to current construction season <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED, <br />List persons zher than applicant who are authorized by you to <br />•PPl/ permits under your license _ _ _AfAity _ _ _ <br />Date <br />The undersigned hereby makes application to the City of <br />Orono, Minnesota, for.license to install and repair septic <br />systems, and/oi, pump out septic tanks, subject to the laws.: <br />of the State of Minnesota and the Ordinances of the City of <br />Applicants Signature £/'2JaJ^^ <br />Staff reco^imandation Approval <br />Reason for denial: <br />Denial Date <br />City Council Action Date <br />^ - H v .. ^ f <br />i« dflAlHi. ________ <br />Approved Denied