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� 1'•MI Inuu: i.o. .... <br />CAR TTr of ORO O c.ys.l My, Minnerom uan SEPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />aUILOe1D a ZONING - 4134331 <br />AiSFbMNG <br />All questions must De answereu. Ioo, ....•••., ..�.. ._......- <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 �♦ �' As"n x- <br />2. Business address a'Y1/S tL. 121 LL <br />3. Business phone a/(7� -d(3G/ Residence phone ;,,i.rt <br />4. Name of applicant or company ��r ppresentative holding MPCA <br />certification /, +k /J // .Johnsen <br />5. Type of certification helds _IL�Ilnstaller _ Pumper <br />Site evaluator System designer ! <br />-is—this a ProvisionaY ertif icate? `/&_ Certificate No.-Ew <br />6. IE I.o Certificate is held, provide evidence of attendance at <br />one of the On -Site Sewage Treatment Workshops held immediatel <br />prior to the current construction season. <br />7. Have you ever held a Septic System Installer license in <br />Orono before? list Most recent year /9P7 <br />� � 1 <br />8. Have you ever had a /tcens� revoked?,g2_ when? <br />Where? <br />9. Do you do Municipal Sewer hook-ups? Yea ✓ No <br />SUBMITTALS REQUIRED: <br />1. $25.V license application fee. i+s` <br />2. $2000.00 license and permit bond naming City of Oronn as�.f <br />T,,� obligee. The State Plumbers Bond will not be accepted. <br />3. $10-50-100,000 minimum Certificate of Insurance. CtA,710)aCOS <br />$. Copy of current MPCA Certificate or evidence of afp[(11012" <br />at On -Site Sewage Treatment Workshop held immediatfy OFFICE <br />prior to current construction. Beacon. 0 4 G, .5.V ._ <br />LICENSES WILL NOT BE PPOCESSED UNTIL ALL ITEMS ARE SUB6ffEp.TL .^5.00 <br />List persons other than applicant who are authorized by R"PbJ YOU <br />apply for permits under your Iicense iYsv/e. HAiw m! m Tosai <br />The undersigned hereby makes application to the City of', 01091W <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 />Orono. -*, S-1 n <br />Date <br />Applicants <br />Staff recommendation Approve Denial Dat^ <br />CITY Reason for denials <br />USE City Council Action Date Approved _ Denied <br />ONLY Date licenao moiled <br />