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CITY <br />USE <br />ONLY <br />ORONO Cryaul Bay. Minnoaota 55323 <br />building & ZONING - 473-7357 <br />assessing <br />SEPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />1 questions raust be answered. License fee, bond, certificate <br />iLurance, and evidence of MPCA Certxrication or Horae Sewage <br />featment Workshop attendance raust accompany this application. <br />,11 aoplications are subject ten (10) day approval period. <br />1. Business or trade name ^^- - - - - <br />2. Business address 7 ?^ <br />3. Business phone Residence phone <br />4. Name of applicant^i corapai^ irepresentative holding MPCA <br />certification - - - - - --- - - - - - - - -— <br />5. Type of certification held: Installer - - - Pumper <br />Site evaluator _ _System designer /^}<? <br />Is this a Provisional Certificate? _ _ _ Certificate No./ j/J <br />6. If no Certificate is held, provide evidence of attendance at <br />one of the On-Site Sewage Treatment Workshops t .d immediately <br />prior to the current construction season. <br />7. Have you ever held a Septic System Installer lice: ?e in <br />Orono beforeMost recent year ^ <br />8. Have you ever had a license revoked? )^C When? - - - - - <br />Where? _ _ _ <br />§. Do you do Municipal Sewer hook-ups? Yes_ _ _ No- - - - - <br />l6~. Do you pump out septic tanks? Yes_ _ _ <br />QJ^ <br />3. <br />4. <br />SUBMITTALS REQUIRED: <br />0^ 1. $25.00 license application ! <br />2. $2000.00 license and permit bond naming City of Orono as <br />obligee. The State Plumbers Bond will not be accepted. ^ <br />$10-50-100,000 minimum Certificate of Insurance. ty.7.^/ <br />Copy of current MPCA Certificate or evidence of attendende <br />at On-Site Sewage Treatment Workshop held immediately <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 />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 />St ) . ® recommendation ^pprov^ <br />Reas, .-k for denial: <br />Denial Date //-/7- JO <br />City Council Action <br />Date license mailed <br />Date Approved Denied