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SEPTIC <br />YSTEM <br />CITY of C J II11���� LICENSES APPLICATIONLLERS <br />All mue� w auaw r .. w.. oa cc, w...., ..c•.. .a.. ..� <br />of insurance, and evidence of 14PCA Certification or Home Sewage <br />Treatment Workshop attendance must acc:mpany this application. <br />All app'.lcatlons are subject to a ten (101 day approval period. <br />i <br />1. Business or trade name L:l, I/n = S Se�.�rrt CLA/uR <br />]- Anaineaa address It r i / Illa��s Qf"6, <br />3. Business phone 4Z6 -'3 7 % 2 Residence phone SAril <br />4. Name of applicant or company rep resentative holding 14PCh <br />certification s�,„ Pis;' ,..s_ <br />�i <br />5. Type of ceeval evaluator. he lye � Installer Pump �S l <br />Site evaluator System signer <br />Is tthis a Provisioner Certif icate7 Certificate <br />6. If no 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 helfg1 a Septic System Installer license CfXYOF ! <br />Orono before? v Most recent year / yK7 FINANCE OFF <br />'/ <br />i <br />8. Have you ever had a license revoked? Nd When? 1J11500000 I <br />Where? --'e Ca 5.00 <br />9. Do you do Municipal Sewer hook -opal Yes <br />-Z No G4Ef1", TL 5.00 <br />—�eneror_rueaw <br />SUBMITTALS REQUIRED: k061V0 CON ROl'TIN? <br />/ ovl1 BB I <br />1. $25.Or license application fee. <br />2. $2000.00 license and permit bond naming City of Orono as 0. <br />obligee. T.e State Plumbers Bond will not be accepted. 1 <br />_ 3. $10-50-100,000 minimum Certificate .f Insurance. W.t I-bb <br />_ 4. Copy of current MPCA Certificate or evidence of atteridence <br />at On -Site Sewage Treatment Workshop held immediately <br />prior to current construction season. <br />LICENSES Ylrlt, 41)T BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED. <br />List persons: other than applicant who aXa nut orired Dy yo- -• , <br />apply for permits under your license Sln ..Tn„ n.. 15"qQ s <br />The undersigned hereby makes application to the City o <br />Orono, Minnesota, for license to install and repair septic <br />systems, and/or pump out septic tanks, subject to the lawn <br />of the State of Minnesota and the ordinances of the City Of <br />Orono. I <br />Data ?- -IO - T5 Applicants Signature <br />CITY Staff rccommundation Approval X_ Denial _ Date 2-92 OLE <br />Reason fo- denial, <br />USE City Council Action bate pprovo_ Danie— u <br />ONLY Date license mailed <br />