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r-> <br />%'p . <br />■/ <br />ii <br />?' <br />i-;' <br />S, <br />. V ; <br />V <br />SEPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />“CITY of OKONO <br />(612) 473/73(57 <br />Post Offics/Box 66 <br />Crystal Bayr MN 55323 <br />All Questions must be answered. License fee, bond, <br />Applications are subject to a ten (10) day approval period. <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />Business or trade name ^ juU tv //< (I—^^-C. <br />Business address I ^0 __3. ^ <br />Business phone ^5 V P_ Residence phone —--------— <br />Name of applicant or company representative holding MFCA <br />certification dosS' C( f\ ---------------------------------—— <br />/2< <br />Installer <br />.SCI_ _ <br />PumperType of certification held: _ <br />Certificate expiration date _ <br />Have you ever held a Septic System Installer license in <br />Orono before? Most recent year ---------- <br />Have you ever had a license revoked? JXO----- When? ---------------- <br />Where? _ _ _ ___ _ _ _ __ _ _ _ _ ___ __ _ _ _ _ _ _ _ _ ___ _ _ _ _ _ _ _ _ <br />Do you do Municipal Sewer hook-ups? Yes <br />Do you pump out septic tanks? Yes <br />No <br />No X <br />cm DF DRQHQ <br />nSANCE OFFICE <br />lJil50Q{ <br />01 CEH 50 <br />CHECK TL 5t <br />RECEIPT-iHAHK r, <br />H248230 coot M <br />|2Sio!oo\^f«n,rAAr;rrS;it^ro;d naming City of Orono as <br />obligee. The State Plumbers Bond wil.l not be acc^ted.rv». iS <br />2, $50-100-300,000 minimum Certificate of Insurance, <br />77^ 4, Copy of current MPCA Certificate. ^p, <br />SUBMITTALS REQUIRED: <br />U^l <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARB SUBMITTED <br />List persons other than applicant who are authorized by you to apply <br />for permits under your license _ __ _ _ _ _ _ _ __—-—*- - - - - - - -- - <br />The undersigned hereby makes application to the City <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 City of Orono. <br />Applicant’s Signature <br />Staff recommendation <br />Reason for denials _ _ _ _ <br />City Council Action Date <br />Date license mailed <br />Approved <br />Date <br />Denied <br />- ' • —niii'niMrutiieh -