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/ Cry.bl li.y, Minrwnb GSa27 SEPTIC SYSTEM INSTALLERS <br />Cg T T o ORO ® I LICENSE APPLICATION <br />OUILDING A ZONING - tlb11Sy <br />AMUSING i <br />All questions must be answered. License fee, bond, cert f cote <br />of insurance, and evidence of MPCA Certification or Home Sewage <br />Treatment workshop attendance must accompany this application. <br />All applications are subject to a ten (10) day approval period. <br />1. Business or trade name Widmer Inc. <br />2. Business address P.O. Box 219. St. Bonifacius. MN 55375 <br />3. Business phone (612) 446-1495 Residence phone <br />4. Name of applicant or company representative holding MPCA <br />certification <br />5. Type of certification heldl x Installer _ Pumpers <br />Site evaluator System _cTesigner <br />Is this a ProvisionaI —Certif icate? _ Certificate No.1L <br />6. If no Certificate is held, provide evidence of attendance at <br />one of the On -Site Sewage Treatment Workshops held immediate <br />prior to the current construction season. <br />7. Have you ever <br />held a <br />Septic System Installer license C#. OF 0 <br />Orono before? <br />Yen Most recent year 1987 <br />FINANCE <br />OFFI <br />E <br />B. Have you ever <br />had a <br />license revoked? no <br />When? 0 CI ao <br />5.N <br />Where? <br />—?Tff— R <br />5.00 <br />9. Do you do Municipal <br />Sewer hook-ups? Yes_ <br />No RECEIPT-NVA <br />X <br />S`U/BMITTALS REQUIRED, <br />1. $25.0( license application fee. <br />2. $2000.00 license and permit bond naming City of Orono as <br />obligee. The State Plumbers Bond will net be accepted. <br />-�` 3. $10-50-100,000 minimum Certificate of Insurance. <br />4. Copy of current MPCA Certificate or evidence o° 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 persona other than applicant who ar author0lzet <br />apply for permits under your license G.H. Pl'idmer, nrl 1 e unn Widmer, <br />The undersigned hereby makes appli�f—pl16lhvfadelrilnt*ft0praf Cnrdlnal <br />Orono, Minnesota, for license to install and repairseptic <br />systems, and/or pump out septic tanks, subject to t?ie laws <br />of the State of Minnesota and the ordinances of the City,of <br />Orono. / <br />Date 7-2-98 Applicants Signature <br />CITY Staff recommendation Approval Denial Date i-Z <br />USE Reason for denielr ^ <br />ONLY City Council Action Date ApprovedDenied <br />Data license mailed <br />