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CITY of ORONO Crystal Bay. Minni 55323 SEPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />building a zoning - 473-7357 <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 attendence must accompany this application. <br />All applications are subject to a ten (10) day approval period. <br />1. Business or <br />2. Business address <br />trade name /7j/( 6o <br />3. <br />4. <br />5. <br />6. <br />7. <br />8. <br />Business phone V/^3^ Residence phone <br />Name of applicant o^company representative holding MPCA <br />certification her-_ _ ___ _ _ _ _ _ _ _ _ _ _ _ _ _ _— <br />/ Installer _ _ Pumper <br />Certificate No <br />Type of certif cation held: _ _ <br />Site evaluator _ _System designer <br />Is this a Provisional Certificate? _ _ <br />If no Certificate is held, provide evidence of attendance at^ <br />one of the Gn-Site Sewage Treatment Workshops held immediat*^^), <br />prior to the current construction season. <br />Have you ever held a Septic System Installer license in <br />Orono before? ^ Most recent year 0S> <br />Have you ever had a license revoked? When? <br />Where? <br />Do you do Municipal Sewer hook-ups? Yes /No Of oRm <br />-f^CE uFFIC <br />CITY <br />SUBMITTALS REQUIRED: <br />^ 1. $25.00 license application f^. TL - <br />2. $2000.00 license and permit bond naming City of ynu <br />obligee. The State Plumbers Bond will not be tac. <br />\/^2. $10-50-100,000 minimum Certificate of Insurance. <br />Oi OEH S5.0( <br />Cory of current'MPCA Certificate or evidence of attendence <br />at On-Site Sewage Treatment Workshop held immediately <br />prior to current construction season.01/23A <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED- <br />List persona other than applicant who are authorized by you to <br />apply for permits under your license - - -- - - - -— <br />The undersigned hereby makes application to C^fy ^ <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 or <br />Orono. <br />Date 7- 2J^ ^7 Applicants Signature <br />CITY <br />USE <br />ONLY <br />Staff recommendation I <br />Reason for denial: _ <br />City Council Action <br />Date license mailed <br />Approval Denial Date /-2S-g9 <br />Date Approved Denied