08-10-1992 Council Packet - Laserfiche WebLink

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'TJ “r ■• *-■■•, .;-^r ;v •X' ff OKONO (612) ft71-7357 Post OTface Box 66 Crystal Bay# MN 55323 SEPTIC SYSTEM INSTALLERS license APPLICATION All questions must be answered. License fee, bond, 1. 2. 3. 4. CnW^cNj Pl^^VviftXOoBusiness or trade name _________ Business address O O C V j>c \^V c V s Business phone _ Residence phone Name of applicant or company representative holding MPCA certification 5.Type of certification held: ^^^^*^Insta. Certificate expiration date \ b Pumper 6.Have you ever held a Septic System Installer license in Orono before? Most recent year ---------- 7.Have you ever had a license revoked? Where? _ _ _ _ ___ _ _ _ _ _ _ _ _ __—-- - - - - When?Cin OF ORiM) ^-FiHAHGE OFFICE rJUSOf) 8. 9. Do you do Municipal Sewer hook-ups? Yes Do you pump out septic tanks? Yes - - No 01 CEH 50,00 CHECK. R 50,00RECEIPT-Wm YOU ffE4S6SO cool ROl 708:08/03/ SUBMITTALS REQUIRED: 1^1. $50.00 License application fee. 17^2. $2000.00 license and permit bond naming City of obligee. The State Plumbers Bond will not be accepted. |/^3. $50-100-300,000 minimum Certificate of Insurance. ~p/4*. Copy of current MPCA Certificate. LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED List persons other than applicant who are authorired by you to apply for permits under your license- - - --- - - - - - - - - - - - --- - - - - - - - - ix- and/or pump out septic tanks, subject to the laws of the State of Minnesota and the Ordinances of the Ci^ of Orono. \ r~ I ^—*72Date j? -^g. Applicant's Signature CITY USB cmLY Staff recommendatio^<^^^^prov^ Reason for denial: Denial Date City Council Action Date Date license mailed _ _ _ Approved Denied ?/-