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ITYrfitttONO <br />Post Ullice oo» <br />Cryttd Bay. Minn-oto S5323 <br />building a zoning - 473-73:;7 <br />assessing <br />SEPTIC SY <br />LICENSE A <br />anfevidenirofOTCA"cer“ficaaoro; <br />Business or trade nan* iO^^.- - - - -- <br />Business address U{^Wa.Y U ■ ff\(^kPb.W <br />Business phone Residence phone V77-^Sg- <br />1. <br />2. <br />3. <br />4.Name of ap^ <br />certification <br />representative holding MPCA <br />Installer <br />certificate «o ./M <br />r^r^ ror<-ificate is held, provide evidence of attendance at <br />oL of the On-sI?elewage'Treatment Workshops held immediately <br />prior to the current construction season. <br />Have you ever held a Septic System Installer <br />Orono before? ____ Most recent year _ <br />Pumper <br />7. <br />8 <br />10. <br />Have you ever had a license revoked? <br />Where? _ _ _ <br />Do you do Municipal Sewer hook-ups? Yes. <br />Do you pump out septic tanks? Yes <br />A/q When? <br />SUBMITTALS REQUIRED; <br />ysL'6o?oSl!=lnsraifpermit'boAd naming City of Orono <br />Obligee. The State Plumbers Bond will not be <br />$10-50-100,000 minimum Certificate of \ ^ <br />Copy of current MPC\ Certificate or evidence <br />a/on-Site Sewage Treatment Workshop ^Id <br />prior to current construction season.^r \Z <br />I^CO W' **VS^3. <br />0^ - ■ <br />int <br />LICENSES WILL MOT 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 />systems and/or pump out septic tanks, subject to the laws <br />Qf the State of Minnesota ^d the Ordinals of th^i^ o <br />Date^^^<^ Applicants Si^ature^^^<^^i^^(^!^^ <br />Staff recommendation”^ Date”^^^^^2^. <br />Reason for denial; <br />City Council Action <br />Date license mailed <br />Date Approved Denied