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CiiYof ORON CryMal Buy, Muuiwota S5383 SEPTIC SYSTEM INSTALLERS LICENSE APPLICATION <br />I - <br />r <br />:xTt <br />ifl <br />IMLY <br />building a zoning - 473*7357 <br />assessing <br />1. <br />2. <br />3. <br />4. <br />e <br />W • <br />Business or trade name ^ Srhs—E~X^C(lL*^ <br />Business address 1 Set, fUrnirc^ i 07 n <br />\r-LCard’*t^ <br />Business phone Residence phone A <br />Name of applicant or company rt^ 2s,3ntative holding MPCA <br />' J4a^ <br />X InstallerType of certification held: _ _ <br />Site evaluator _ _System designer <br />Pumoer <br />Certificate No 3^^ <br />6. <br />7. <br />8. <br />Is this a Provisional Certificate? <br />"?Se"oi-irte ' T?«:^nt"wo1*sh=pr'h:J ^ "i^dLJ^Xy <br />prior to the current construction season. <br />Have you ever held a Septic System Installer license in <br />Orono before? Most recent year / / 70, <br />Have you ever had a license revoked? AACL When? _ <br />Where? _ _ _ <br />Do you do Municipal Sewer hook-ups? Yes , No <br />No <br />wa » I ui* w»\ <br />ICf” Do you pump out septic tanks? Yes <br />SUBMITTALS REQUIRED: <br />obligee. The State Plumbers Bond will not be accS(0tWr^..^^^^ <br />✓ 3. $10-50-100,000 minimum Certificate of Insurance. SiW/w.'" <br />— 4. Copy of current MPCA Certificate or evidence of attendance v^/xx. <br />at On-Site Sewage Treatment Workshop held iamiediately r.. <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 you to <br />apply for permits under your license 16f)aa^ <br />The undersigned hereby makes application to the City of <br />Orono, Minnesota, for license to install and repair septic <br />systems, and/or pusv out septic tanks^ subject to the lavs, <br />of the State of Minnesota and the Ordinances of the City of <br />Orono. . * <br />Date 2^1^ f/ Applicants Signature <br />Staff recoaswndation (^proval^JES^O®***^*^ <br />Reason for denial: " <br />Date <br />City Council Action Date <br />Date license nailed _ _ <br />Approved Denied