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: V*»' • <br />ijITYof OKONO <br />(612) 473-7357 <br />Post Office Box 66 <br />Crystal Bay# MN 55323 <br />SEPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />All questions must be answered. License fee, 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 />Business or trade name E>cl ^ f hyt r-a /r ✓<> -// <br />Business address Ac' P/iCL / >7 <br />Business phone 3>^Residence phone i'yf ^ <br />2.- ■■■4 <br />Name of applicant or company representative holding MPCA <br />certification ph )/;p <br />Type of certification held* Installer <br />Certificate expiration date ^3____ <br />Pumper <br />Have you ever Jield a Septic System Inrtaller license in <br />Orono before?Most recent year <br />Have you ever had a license revo)ced7 <br />Where?Mk When? <br />Do you do Municipal Sewer hook-ups? Yes X <br />Do you pump out septic tanks? Yes _ _ _ _ No <br />No <br />X cm cF Df<m <br />-mrrtCt^FICE <br />||v 8PBMZTTAL8 RBQOIRED: <br />1. <br />P <br />If <br />1-' <br />'pJr <br />f ^ * <br />t •^3. <br />4. <br />misooooo <br />Ot C£H 50.00 <br />650.00 License application fee. <br />62000.00 license and permit bond naming City of Orontf^Hf <br />obligee. The state Plumbers Bond will not be acceptewt-^ T0A:3t. <br />650-100-300,000 minimum Certificate of Insurance. 05/20/92 <br />Copy of current MPCA Certificate. £5^, <br />f.' ■. <br />LZCBWB8 HILL MOT BE PROCESSED UNTIL ALL ITOIS ARB SUBMITTED <br />h' I <br />^‘-^Liet persons other than applicant who are authorized by you to apply <br />for permits under your license datctyp* U)i^k 3.Fro¥r\_______________ <br />The undersigned hereby makes application to the City of Orono, <br />' # Minnesota, for a license to install and repair septic systems. <br />«»d/or pump out septic tanks, subject to the laws of the State of <br />^ Minnesota and the Ordinances of the City of Orono. <br />jNlte /y— Applicant's Signaturercmiff:iMLT <br />Staff recommendation Approval <br />Imaaon for denials _ _ _ _ _ _ _ __ <br />City Council Action Date __ _ _ <br />Date license mailed <br />Denial Date <br />Approved Denied <br />f <br />MU __. f. <br />■I <br />4 <br />■X' <br />y: