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ITYof ORONO Crystal Bay, MinncsoU 55323 SEPTIC SYSTEM INSTALLERS LICENSE APPLICATION <br />BUILDING & ZONING - 473-73S7 <br />ASSESSING <br />All questions must be answered. License fee, bond, certificate <br />of insurance, and evidence of MPCA Certification or Home Sewage <br />Treatment Workshop attendance must accompany this application. <br />All applications are subject to a ten (10) day approval period. <br />trade name -f-JA ye.£ <br />2. Business address \ ga-xoo} Vn <br />ii/t f I <br />V7t-3M/3. Business phone 9-7.a. ? ,Ty i Residence phone <br />Name of applicant or company representative holding MPCA <br />certification _ _ _ _ <br />5.Type of certification held: β€˜X Installer _ _ _ Pumper <br />____ Site evaluator ____System designer . <br />Is this a Provisional Certificate? h/o Certificate No. bt " <br />6. If no Certificate is held, provide evidence of attendance at <br />one of the On-Site Sewage Treatment Workshops held immediateli <br />prior to the current construction season. <br />7. <br />8. <br />Have you ever held a Septic System Installer license in <br />Orono before? ya* Most recent year 1^/9 <br />CITY QF on <br />Have you ever had a license revoked? ytt> When? Fli^^CE <br />fWhere? <br />Do you do Municipal Sewer hook-ups? Yes_ _ _ ^ No <br />10. Do you pump out septic tcuiks? Yes_'kM <br />SUBMITTALS REQUIRED: <br />1. $25.00 license application fee. <br />^^-2. $2000.00 license and permit bond naming City of Orono <br />obligee. The State Plumbers Bond will not be accepted* <br />/j|^ 3. $10-50-100,000 minimum Certificate of Insurance. <br />4. Copy of current MPCA Certificate or evidence of attendance <br />at On-Site Sewage Treatment Workshop held immediately <br />prior to current construction season. 3,/β€”^ y <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 n,/ jJa.^A/a <br />The undersigned hereby makes application to the City of <br />Orono, Minnesota, for.license to install and repair septic <br />systems, and/or pua^ out septic tEuiks, subject to the laws <br />of the State of Minnesota and the Ordinances of the City of <br />Orono. <br />Date i - β€˜to <br />.«fb <br />Applicants Signature <br />Staff recommendation (feproya]&^j^^^^^rDenial <br />Reason for denial: _ _ _ _ _ _ _ _' _ _ _ _ _ _ <br />City Council Action Date <br />Date license marled _ _ _ <br />Date H -β€˜90 <br />Approved