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UTof ORONO <br />- - --- <br />_ CryMtk Btiy. Minnuf S5323 <br />BUILOINC A ZasINC - 473-735T <br />assessing <br />SEPTIC SYSTEM INSTALLERS <br />license application <br />All qu..tions aust H^meiewage <br />All applications are subject to a ten (lO) o y P. pp r c / . <br />1. Business or trade name \'_ <br />2. Business address ^ <br />•4. <br />^^^siness phone ^'Zo ' ^ ^Residence phone <br />.. y.f “j "g <br />5. <br />Installer Pumper <br />Certificate No.^212. <br />6. <br />7. <br />8 <br />Type of certification held: —^ <br />Site evaluator System designer <br />Is this a Provisional Certificate? - - <br />p^ior to the current construction season. <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? When? - - - - - <br />Where? _ _ _ . <br />DO you do Municipal Sewer hook-ups? ^es_j^ <br />No10< DO you pump out septic tanks? <br />SUBMITTALS REQUIRED* <br />Yes <br />Fli^AaCB OFFICE <br />1-l'T *\ 01 i <br />Obligee" *The State Plumbers Bond will <br />0^ 3. $10-50-100,000 minimum Certificate of ----------- <br />Coov of current MPCA Certificate or evidence of attendance <br />On-Site Sewage Treatment workshop held immediately <br />prior to current construction season.^^ 3»- <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED. <br />List persons other than applicant who^e au^rixed^ <br />•PPly 5orpermits under your license <br />The undersigned hereby makes application to the . <br />Minnesota, lawse^waeems. and/or pump out septic tanks, subject <br />Qf State of Minnesota and the Ordinances of the City o <br />OSOttO* '11.. 3 <br />/Cf / Applicany SignattxreDate _ <br />Staff reeoaBsndatioi <br />EeaaoB for denial* . <br />City Ceuaeil Action <br />Date lieeaee mailed <br />»proval (enial Pate <br />Lpprove<