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ClTYof 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 />1. <br />2. <br />3. <br />Business or trade name <br />Business address y/ 'I/) <br />Business phone Residence phone y yy~ <br />4.Name of applicant yO’r company representative holding MPCA <br />certification <br />5.Type of certification held: ^..^^■^''^nstaller <br />Certificate expiration date /^- <br />Pumper <br />6. <br />7. <br />Have you ever held a Septic System Ir^taller license in <br />Orono before? ]/ IL/jy Most recent year y/ ^ <br />Have you ever had a license revoked? _ _ _ _ _ When? ^ i-. <br />8. Do you do Municipal Sewer hook-ups? Yes No <br />9. Do you pump out septic tanks? Yes No / <br />4 <br />SUBMITTALS REQUIRED:cm if OROh'Q <br />y 1. <br />iC 2. <br />a/^3. <br />$50.00 License application fee. <br />$2000.00 license and permit bond naming City^of c,-. q <br />obligee. The State Plumbers Bond will not be accepte^i- r^'* r^*^, <br />$50-100-300,000 m.i nimum Certificate of Insurance. '’'r’CrcTijr'yuiiiK'X'nir <br />txuLimAI I I iintfiS t v\Jy 4, Copy of current MPCA Certificate.t\uLi.AI I inntfiS t V\J <br />,vVW nrii JnC <br />I rr<Lw'Vw'c'v ow'x iWi ivw <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED <br />f »C* ‘"7V'U*r c I / <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 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 City of Orono. <br />Date y Applicant's Signature .■^r <br />CITY <br />USE <br />ONLY <br />Staff recommendation Approval <br />Reason for denial: <br />Denial Date <br />City Council Action Date <br />Date license mailed <br />Approved Denied