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tmt s I1M1 VIl,n. ,w,. m, <br />CITY o 01\0NO Cry�W nay. Minna 55M, <br />aU1LnING • ZMING - 47IOIS7 <br />ASSMING <br />SEPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />All questions must De anewerea. L,lcenae Loup uuaur per LLxLuoLo <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 <br />.. Business address N7 I ��7C r(01 IIIP//Ill"054?yf£Ih� A <br />3. Business phone 6J 7.A - _ .li Residence phone , 7.1 -.3S 11 <br /><. Name of applicant or company epresentative holding MPCA <br />certification arced iz e � _ <br />5. Type of certification holds C Installer _ _ Pumper <br />Site evaluator System designer <br />IS this a Provisional —Certificate? Certificate No.4ZC3! <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 />RFA <br />e <br />a` <br />a <br />7. Have you ever held a Septic System Installer license iz <br />Orono before? Ve s Most recent year 19 Y 7 CITY OF DROA <br />F!NAYCE OFF <br />S. Have you ever had a license revoked? 7L':; When? ) a 5.00 <br />Where? JEll n15.00 <br />4. Do you do Municipal Sewer hook-ups? Yes X_ No_-*WPT-THAV( <br />o TJ1:J <br />SUBMITTALS REQUIRED: OJ/Oi/: <br />1. $25.0, tense application fee. <br />2. $2000. .tense and permit bond naming City of Orono as .0p <br />ob'igre, The State Plumbers Bond will not be accepted.(0~� <br />3. $1,-50-100,000 minimum Certificate of Insurance. <br />C. Copy of current MPCA Certificate cr evidence of atte.ldence <br />at On -Site Sewage Treatment Workshop held immediately <br />prior to currant construction season. <br />LICZNSES WILL NOT BE PROCESSED UNTIL A '.TEMS ARE SUBMITTED. <br />List persons other then applicant who are authorized by you t9 <br />apply for permits under your license is ,.:e.. A1. ;, r�al4 4g „t � <br />The undersigned hereby makes application to the City of 7 <br />Crono, Minnesota, for license to install and repair septic <br />systsms, and/or pump out 4eptic tanks, subject to the laws <br />of the Rub of Minnesota ant the Ordinances of t`_ City of <br />Orono. E <br />Date 'N— - CY' Applicants Signature (etc +«a � t•1"r' <br />CITY Staff recommendation Approval enial Dots --2 <br />list Reason for derials <br />OMLY City Council Action Data pprova n a <br />Date license wailed <br />