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t'osi \Jinas i>o* ^ <br />CITYirf ORONO Ciyital Bay, Minn—of 56323 SEPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />ITY <br />7SE <br />WLY <br />BUILDING * ZONING - 473-7357 <br />assessing <br />All questions must be answered. License fee, bond, certificate <br />o£ 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 />// 'iX.P ' Ax._ _ _ _1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />Business or trade name <br />Business address 3^2-/^_ _ _ _ _ _ _ _ _ _ _ _ <br />Business phone (^rV~ ^7(31 Residence phone <br />Name of applicant or company, representative holding MPCA <br />certification A — <br />InstallerType of certification held: _ _ <br />Site evaluator _ _System designer <br />Is this a Provisional Certificate? _ _ <br />Pumper <br />Certificate No. I ^ <br />If 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 />U^ve you ever held a Septic System Installer license in <br />Orono before? Most recent year <br />had a license revoked? When?Have you ever <br />Where? _ _ _ <br />Do you do Municipal Sewer hook-ups? Yes_ <br />10. Do you pump out septic tanks? Yes_No X ----i-3H5 <br />rr <br />- rwr 25.00't5-.00 <br />SUBMITTALS REQUIRED: <br />05/10/1. $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.^?<r <br />$10-50-100,000 minimum Certificate of Insurance. /3. if — —— -- ——- - - - - -^ <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— <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED. <br />List persons other than applic^t 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 pump out septic tanks, subject to the laws <br />of the State of Minnesota and the Ordinances of the City of <br />Orono. <br />Date S^/th Applica^s Signature <br />staff recommendatioi <br />Reason for denial: . <br />City Council Action <br />Date license mailed <br />Approval Denial Date S’-n-yO <br />Date Approved Denied