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Post Office Box 66 <br />OROJiTO Crystal Bay. Minnesota 55323 SEPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />Y <br />Y <br />building Jl 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 ^re subject to a ten (10) day approval period. <br />1. <br />2. <br />3. <br />4. <br />Business or trade ncune <br />Business address 7S0 ^ PC//)So^) <br />Business phone *7 58-^3SS Residence phone 73 ’* <br />Name of applicant or company representative holding <br />certification _ _ _ _ _ _ _ _ _ _ _ _ _ _ '*:L <br />5.Type of certification held: _ _ <br />Site evaluator System designer <br />Installer Pumper <br />Is this a Provisional Csrtificate?Certificate No. <br />6.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 />7-Have you ever held a Septic System Installer license in <br />Orono before? A^Q Most recent year _ _ _ _ <br />8.Have you ever had a license revoked? <br />Where? <br />When? <br />Do you do Municipal Sewer hook-ups? Yes_ <br />10. Do you pump out septic tcuiks? Yes V <br />No y <br />ICE <br />_ J V V <br />-3- <br />»_ • V V <br />SUBMITTALS REQUIRED: <br />1. <br />2. <br />/ <br />3. <br />4. <br />$25.00 license application fee. <br />$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. 9-20*^ <br />Copy of current MPCA Certificate or evidence of attendence <br />au On-Site Sewage Treatment Workshop held immediately <br />prior to currer.t construction season. <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED. <br />List persons other them applicanc who are authorized by you <br />naits under your license NAT^j\k( <br />The undersigned hereby makes application to the City of <br />Orono, Minnesota, for .license to install and repair septii? <br />systems, and/or pump out septic tanks,, subject to the laws <br />of the State of Minnesota amd the Ordinances of the City of-II- -uxono. / ] <br />Date y ^ 9 Applic^ts Signatured J - <br />Staff racommendation(^pprovai,//^l'^^ Denial <br />Reason for denial: ^ <br />City Council Action* <br />license mailed <br />Date ^ <br />Date <br />Date <br />Approved Denied <br />License maiiea _ _ _ _ _ <br />^ Pumpouts oajI-y