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ITYof ORONO <br />t-0»l UlUCK t»0* <br />Crystal Bay, Miaecaota 55323 <br />BUILDING 4 ZONING - 473-735T <br />assessing <br />SEPTIC SYSTEM INSTALLERS <br />LICENSE pAP.PLICATION- ... <br />■ ll! <br />r • <br />a • <br />All Questiions must be answered. Licsnse fss, bond, csr^xf'xcHte <br />of insurance, and evidence of MPCA Certification or Horae Sewage <br />Xreatraent Workshop attendance raust accorapany this application. <br />All applications are subject to a ten (10) day approva|^BRrio$. IS <br />1. Business or trade narae <br />2. <br />3. <br />4. <br />Business address <br />Business phone Residence phone <br />Name of applicant or company representat^ive holding MPCA <br />5.Type of certification held; _ _ <br />^^ite evaluator _ _System designer <br />\y Installer Pumper <br />T7fi> <br />Certificate No ./so*? fi.-'W-V <br />2.*^i 93 <br />6. <br />7. <br />8. <br />Is this a Provisional Certificate? <br />If no Certificate is held, provide evidence of attendance at <br />one of the On-Site Sewage Treatment Workshops held immediately <br />prior to the current construction season. <br />Have you ever held a Septic System Installer license in <br />Orono before? Moat recent year <br />Have you ever had a license revoked? iJ<^ When? <br />Where? <br />xuY pf cmFimE arm <br />Do you do Municipal Sewer hook-ups? Yes <br />10^ bo you pump out septic tanks? Yes_ <br />Mo ntisooito <br />UH <br />m Ti <br />iw <br />25^7^ <br />25J» <br />»:i45io cooi m me <br />d2m.T.SUBMITTALS REQUIRED: <br />1. $25.00 license application fee. <br />KZI 2. $2000.00 license and permit bond naming City of Orono <br />obligee. The State Plumbers Bond will not be accepted.*^ <br />dtL, 3. ^10-50-100,000 minimum Certificate of Insurance .415^ <br />e)\c 4. Copy of current MPCA Certificate or evidence of attendence <br />at On-Site Sewage Treatment Wor)cshop held immediately <br />prior to current construction season. <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED. <br />List persons other than applicant who are authorized^ by <br />apply for permits under your license * <br />The undersigned hereby makes application to the City of <br />Orono, Minnesota, for license to install and repair septic <br />systems, and/or pump out septic tanks, subject to the laws <br />of the State of Minnesota and the Ordinagfbp of the CjLty of <br />Orono. <br />Date Applicants Signature <br />infba of the ^ty of <br />UrJ^ \Li4X- <br />Staff rseomsMndatio <br />Reason for denial: <br />City Council Action Oats <br />Date license mailed <br />Denial D«t. <br />Approved Denied