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1'uF\ \IIOV: �w. uo <br />CITY of ORONO, <br />, <br />C,,.Ul R y. Minnertla &%W. <br />OUILDINGarONING 473-7337 <br />ASSESSING <br />SEPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />All questions must be answered. License fee, bond, certificate <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 named Thoinsot) Plccrnhinc� <br />2. Business address I�/NO�//.P7U�%�l Alll;; <br />3. Business phone 4W —�AVI Residence phone <br />t. Name of applicant�,,por comQany rep epentative holding MPCA <br />certification eSLk��Si <br />T <br />5. Type of certification held: J,�' Installer _ Pumper <br />Site evaluator System design r ,� <br />Is tthis a ProvisionaICertificate? 3W Certificate No.� <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 held a Septic System Installer license in <br />Orono before? ✓ Most recent year jq�j <br />8. Have you ever had a license revoked? AL When? I <br />Where? _ <br />9. Do you do Municipal Sewer hook-ups? Yes ✓ No <br />SUB7 <br />ITTALS REQUIRED: <br />�, 1. 525.Or license application fee. <br />v 2. $2000.00 license and permit bond naming City of Orono as <br />obligee. The State Plumbers Bond will not be accepted. <br />p _ 3. $10-50-130,000 minimum Certificate of 2nsurance. fIFy p(t(pp <br />�4. Copy of current MPCA Certificate or evidence of aVJ <br />at on -Site Sewage Treatment Workshop held imme1 <br />prior to current construction season. ti L'a 15.00 <br />LICENSES WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMT'ITnIL 25.O0 <br />List persons other then applicant who a7 9{e <br />apply for permits under your license f / IF.DR <br />The undersigned hereby makes application to the ity OC <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 o the ity of <br />Orono. <br />Date Applicants Signature <br />Staff recommendation Approval Den i Date <br />CITY Reason for denial: u— <br />USE City Council Action Date Approve Denied <br />ONLY Date license mailed <br />