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CITY of ORONO SEPTIC SYSTEM INSTALLERS <br />(6X2) 473-73S7 “CBN®* APPLICATION <br />Post office Box 66 <br />Crystal Bay» MN 55323 <br />All Questions must be answered. License fee, bond, certificate of <br />i^Aurance, tSS 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 />4. <br />5. <br />6. <br />7. <br />8. <br />9. <br />41 <br />Business phone ^^77^ SO*7 ^7 Residence phone - - - - - - - <br />Business address <br />Name of applicai^or company represe^ative holding MPCA <br />certification ^ ,- — <br />Type of certification held: Installer <br />ofii-e evnirat.lon date ______ <br />Pumper <br />you ever held a Septic System Installer license in <br />Orono before? ifg 5 Most recent year <br />Have you ever had a license revoked? <br />Where? ______________________________— <br />aJ 0 When? <br />Do you do Municipal Sewer hook-ups? Yes <br />Do you pump out septic tanks? Yes <br />No <br />No y 13H5L 01 SEN 50.C0 <br />OKX — 150.50 <br />SUBMITTALS RBQOIRBDs <br />RECEiPT-vm rm <br />it2Si7io ceoi m <br />X 1. $50.00 License application fee. «« -t/pX* <br />“1C 2. $2000.00 license and permit bond naming City of Crono as <br />obligee. The State Plumbers Bond will not be accepted. <br />3, $50-100-300,000 minimum Certificate of Insurance. <br />Copy of current MPCA Certificate. <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE 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 <br />and/or pump out septic tanks, subject to the laws of the State or <br />Minnesota and the Ordinances of the Citp^ of Oronor <br />Date O - If ^ Applicant's Signature _( <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