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CITYrfORONO <br />Post Office Box 66 <br />Crystal Bay. Minnesota 55323 SEPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION . <br />BUILOING 4 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. <br />2. <br />3. <br />4. <br />Business or trade name _ _ _ _ _ _ _ <br />Business address ^ •- - <br />Business phone V77-/^// f Residence phone J>^.1_ <br />name of applicant or company representative holding MPCA <br />certification tf Cf_ _ __ _ _ _ _ ___ _ _ _ _ _ <br />6. <br />7. <br />5. Typo of certification held: Installer - Pumper <br />>C Site evaluator >Csystem designer <br />Is this a Provisional Certificate? _ _ Certificate No. <br />If no Certificate is held, provide evidence of attendance at <br />one of the On-Site Sewage Treatment Workshops held immediatelj^ <br />prior to the current construction season. <br />/V'rnt.to. w/THave you ever held a Septic System •‘^^stal^r^icense in-- ‘ <br />Orono before? Most recent year //f5rrnmj <br />8.Have you ever had a license revoked? PO When? <br />Where? <br />Do you do Municipal Sewer hook-ups? Yes X. <br />10. Do you pump out septic tanks? Yes_ _ <br />.-•cwA <br />~E‘zIPT^Tar>yi <br />No^ <br />fZ-l <br />r- <br />u <br />CE <br />-:r . <br />• f « <br />-r • <br />«w* t t <br />fCU <br />SUBMITTALS REQUIRED: <br />^0^1, $25.00 license application fee. <br />f ^ 2. $2000.00 license and permit bond n2uning City of Orono as . <br />obligee. The State Plumbers Bond will not be accepted <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 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, sul'ject to the laws <br />of the State of Minnesota and the Ordinancethe City of <br />Orono. ^ <br />Date <2- 7"Applicants Signature yj <br />CITY <br />CSE <br />ONLY <br />Staff recamraendation^^-^pprovaJl^y^^^ <br />Reason for denial: ^ _ _ _ <br />City CouTicil Action Date _ _ _ _ _ _ <br />Date license mailed _ _ _ _ _ _ __ <br />Date <br />Approved Denied