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Cri"fof ORONO <br />Post Offica Box 66 <br />Crystal Bay. Minnesota 55323 SEPTIC SYSTEM ‘ ' “ <br />LICENSE APPLICATI <br />:iTY <br />JSE <br />"‘NLY <br />BUILDING 4 ZONING - 473*7357 <br />ASSESSLNG <br />All Questions must be answered. License fee, bond, certificate <br />of insurance, and evidence of MPCA Certification or Home Sewage <br />Treatment Workshop attendence must accompany this application. <br />All applications are subject to a ten (10) day approval period. <br />Business or trade name r'^ r ^ f ^0— <br />Business address ^4- , In - 73 <br />1. <br />2. <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />§. <br />-t <br />Business phone ^‘I“1Residence phone -- - - - - - <br />Name of applicant or company representative holding MPCA <br />certification _ _- - - - - - - - - - - - - - - - - - - - - - - - - -- <br />InstallerType of certification held: _ _ <br />Site evaluator _ _ _System designer <br />Is this a Provisional Certificate? _ _ _ <br />10. <br />Pumper <br />Certificate No./v^V/ <br />iz-3i <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 />Have you ever held a Septic System Installer license in <br />Orono before? Most recent year ^2_ _ <br />Have you ever had a license revoked? ^ O When? ________ <br />Where? _ _ _ ^ <br />Do you do Municipal Sewer hook-ups? Yes_ _ <br />E)o you pump out septic tanks? Yes_ _ _No <br />No^ <br />SUBMITTALS REQUIRED: <br />OvL 1. $25.00 license application fee. <br />/fe" 2. $2000.00 license and permit bond naming City of <br />obligee. The State Plumbers Bond will not be accepted.t>r,y <br />3. $10-50-100,000 minimum Certificate of Insurance. <br />4. Copy of current MPCA Certificate or evidence of attendence <br />at On-Site Sewage Treatment Workshop h^d immediately <br />prior to current construction season/2-"2/-^/ <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 pump out septic tanks, subject to the laws <br />of the State of Minnesota and the Ordinances of the City of <br />Date Applicants Signature <br />r^nnmmendation^ A^rova^"l^(^i^^^5^eniaA,_ _ <br />Paa eon -For* denial: —--_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ <br />Date <br />Reason for denial: <br />City Council Action <br />Date license mailed <br />Date Approved Denied