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irrYof ORONO Crystal Bay, Miiuwao** 55323 lizBsz <br />BUILDINC a zoning - 473-7357 <br />assessing <br />certif ica“te <br />:ririsur»nce, and evidence_^o£ MPCA Cej--*^ <br />si-fj ------------------------ <br />(U lc^xiAiAf^ ^ <br />1. <br />2. <br />3. <br />4. <br />Business or trade name <br />Business address //C. <br />Businas, phone ^r.L - Residence phone <br />Name <br />cer <br />a of applicant^r company ® <br />tification 7>-. (*^/clA A *V///IX^ if <br />Pumper-- <br />$ „..aIs this a Provisionaj. Gertie.ica-e. <br />t . Si. <br />7.ToXfVrV^ Lsf «=eK^;2ar^X!^:*-' <br />8.Have you ever had a license revoked? When? <br />Where ? <br />10. <br />Do you do Municipal Sewer hook-ups? Yes_/ <br />Do you pump out septic tanks? I'es <br />/K- <br />y. <br />SUBMITTALS REQUIRED: <br />i: fio=i??oJ1!rnsrIirpeiS^-‘-nd naming Cify of Orono <br />obligee, _ The State_Plu^ers Send will ^Obligee, xne rj.u*i4A^=^^ -- - <br />3. SlO-50-100,000 minimum Certificate of Insurance, ''' <br />“ 4. Corny of current MPCA Certificate or <br />a^'o^.-Sits Se-wace Treatment ’.erkshop held xamteciately <br />prior to ciirrent construction season. <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED. <br />uZiJ,y. <br />The undersigned hereby makes applica-ion <br />Orono, Minnesota, for license to <br />systems, and/or pusgi out septic tanks, citv of <br />of the State of Minnesota and the OrdxnaneSs o^ the Cx y <br />Ojrono. / / / f y'/ ^ <br />Date 9/ Applicants Sicnature)/ <br />/> <br />,/ / <br />Staff recommendation Approval <br />Reason for denial: __ _ _ <br />City Council Action Date <br />Date license mailed __ _ <br />'Denial Date