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irrr^cwoNO CnrtulBay.SEPTIC SYSTEM-INSTALLERS LICENSE APPLICATION <br />Iv <br />Iv <br />E <br />if <br />h <br />r <br />Ur <br />hi <br />BUILDING * ZONING - 473-7357 <br />assessing <br />AU_qu.stions BOTO^wSdl:Sr,ria:nL ”;r,ffCr5iriific.tion or ISfc <br />Su wlicHtions Ire eubjecr to a ten (10) day approval period. <br />1. Businees or trade name _ (^forfy I.Ci^ v, _, <br />2. Bueiness address (.■^‘7 /'Z> <br />3. Business phone Residence phone ^/V,- <br />4.Name of applicant or cas^any r^ <br />certification > .//■. ■ nicr^ uX.. <br />resentative holding MPCA <br />5.Type of certification held: _ _ <br />Site evaluator _ _System designer <br />• B <br />Installer Pumper <br />Is this a Provisional Certificate?Certificate No .It <br />6.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 InstaUer license i^ <br />Orono before? _ Most recent year ' - n_ . ^ <br />« . — — «> fc • \ m m <br />8 Have you ever had a license revoked?— When? <br />Where? <br />« •• <br />$ <br />10. <br />Do you do Municipal Sewer hook-uts? <br />Do*you pump out septic temks? Yes ^ <br />No / <br />;X <br />SUBMITTALS REQUIRED: <br />*/l. $25.00 license application fee. <br />2. $2000.00 license and permit bond naming City of Orono as <br />at* On-Site Sewage Treatment Workshop held immediately <br />prior to current construction season. i?'5hV‘ <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 <br />The undersigned hereby makes application to the City of <br />Orono, Minnesota, for license to install and repair septic <br />systems, and/or punq? out septic tanks, subject to the laws <br />of the State of Minnesota and the Ordinances of the City of <br />Oronp. / <br />Date f Applicants Signature » t <br />, , /0 4 / <br />* , / / <br />Staff recommendation Approval t^V^^Denial <br />Reason for denial: _____ <br />City Council Action Date <br />Date license mailed _ <br />Date i • <br />t - <br />Approved Denied