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pp; <br />'� suann+r, w iAtli,�� <br />nu <br />All questions must be answers se tdt+, ond, certificate <br />of insurance, and evidence of MPCA Cerfrrlvat.Un or Home Sewage <br />T --atment Workshop attendence must accompany this application. <br />Ail applications are subject to a ten (10) day approval period. <br />1. Business or trade name ,�1_�i�'_.,, ,,_, A.,.t <br />2. Business address .?G (.- n /lt/ r.,, <br />3. Business phone 117,3- '.A,7lil� Residence phone '�7•i-,.�,l.J- <br />4. Name of applies �c»re�.pr_egeit.avt+,iuve holding MPCA <br />certification y5. Type of certification lhelde Installer Pumper <br />Site evaluator System designer <br />Is this a Provisionar —Certificate? pie_ Certificate No. -17 P, <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? I- ;3J Most recent year /7 <br />i <br />B. Have you ever ad a license revoked? AI/, When? <br />Where? _ <br />0. Do you do Municipal Sewer hook-ups? Yes 1/ No <br />SUBMITTAL 4QL_RED[ <br />CITY OF ORM <br />g25.0(. license application fee. FINA,'f,E OFFICE <br />2. $2000.00 license and permit bond naming City of139M pas p <br />obligee. The State Plumbers Bond will not be accept <br />3. $10-50-100,000 minimum Certificate of Insurance. <br />4. Copy of current MPCA Certificate or evidence o1c4cAtendInce ,,$,00 <br />at on -Site Sewage Treatment Workshop held immediiULY-T" YOU <br />prior to current construction season, k051010 CXI RO1 T12:O3 <br />01/1" <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 u dex yyqqur license <br />The undef sIijned' e`r'ibyces application to the City of <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. (( pp <br />Date .7 -.4 - S P Applicants Signature <br />CITY Staff recommendation Approvalxi Denial _ Date ^41 <br />USE Reason for denide <br />ONLY City Council Action ate prove Dania <br />Date license mailed <br />