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DITYof ORONO CrysUl Bay. Mmnesou 55323 <br />SEP'^IC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />BLILDI.NC i ZONING - 4-3-'35 <br />assessing <br />:ijrev!denrcr«pcrcer?!fl«;ioro; Ho^rie^gl <br />Treatment Workshop attendence y‘’3®.,rovirperiSd. <br />All applications are subject to a ten ( ) y <br />1. <br />2. <br />3. <br />4. <br />Business or trade name _ <br />Business address _ _ _ _ _ _ _ <br />®''SSbS^ <br />Business phone Residence phone H <br />5./.x^nstalTyoe of certification held: __ <br />Site evaluator _ _System desicner <br />Pumper <br />Is this a Provisional Certificate?Certificate No. <br />6.Tf r^r^ rorMficate is held, provide evidence of attendance at <br />oL of the On-Site Sewage Treatment Workshops held immediately <br />prior to the current construction season. <br />7. <br />8. <br />10. <br />Have you ever held a Septic System Installer license in <br />Orono before? Most recent year ,,/^l'lQ <br />f rrjy QC ^ <br />Have you ever had a license revoked? when? ---------f/A'AVii <br />Where? _ _ _ _ 1311500(^ <br />;0i CFH <br />TLDo you do Municipal Sewer hook-ups? Yes /- <br />Do you pump out septic tanks? Yes <br />HECK. <br />mcrre.4 <br />25. OC <br />SUBMITTALS REQUIRED: <br />kECEIPT-THm you <br />vS/2V <br />ld^S25.00 license application fee. . . .e ^ <br />2^^^^2000.00 license and permit bond naming City of <br />obligee. The State Plumbers Bond will not be <br />3p^$10-50-100,000 minimum Certificate of Insurance.£np. t'>Jl 91U-3U-1UU,UUU niiiixiuiAiu * I-*.. *w—-w w- - - - - - - - - -- - ^ <br />4i?<topy of current MPCA Certificate or evidence o. at^renaence <br />at On-Site Sewage Treatment Workshop held iromediat-ly <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 <br />The undersigned hereby makes application to the City of <br />Oronor Minnesota, for license to install and repair septic <br />systems, and/or pump out septic tanks, subject to the xaws <br />of the State of Minnesota and the Ordinan^Lgs of the^ity or <br />Orono. <br />Date 11 <br />Staff recommendation Approval <br />Reason for denial: <br />Applicants Signature <br />^Denial Date I <br />City Council Action Date <br />Date license mailed _ _ <br />Approved Denied