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CITY c�4{0110 TO <br />C".WI It.,. Minnem4, 410141 <br />III'ILnIVf. a LnpliG 47373S7 <br />ASS:SSIM, <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 attendence must accompany this application. <br />All applications are subject to a ten (10) day approval period. <br />n <br />1. Business or trade name <br />2. Business address /a •l r, e ' '� s? <br />3. Business phone # %? ./,rig evidence phone _ <br />4. Name of applicant or company representative holding MPCA <br />certification yt -- ice, _ �% •.4'., <br />S. Type of certification held: installer _ Pumper <br />Site evaluator Systemesigner <br />Isthis a ProvisionalCertificate? _ Certificate No.=21- <br />6. I£ no Certificate is held, provide evidence of attendance at <br />one of the On -Site Sewage Treatment Workshops held immediately <br />prior to the current construction season. <br />7. Have you ever held a Septic System Installer license in <br />Orono before? t Most recent year � 3 <br />E. Have you ever ad a license revoked?AQ— When? <br />Where? _ <br />9. Do you do Municipal Sewer hook-ups? Yes V No <br />SUBMITTALS REQUIRED: <br />✓ 1. $25.0r license application fee. <br />2. $2000.00 license and permit bond naming City of Orono as <br />obligee. The State Plumbers Bond will not be accepted. <br />�, gq 3. $10-50-100,000 minimum Certificate of Insurance. <br />3� �4. Copy of current MPCA Certificate or evidence of af;lbhaiidctl�_E <br />at On -Site Sewage Treatment Workshop held S:maed�atA,�,Z7 <br />a.......,^.J p <br />prior to current construction season. <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 under your license <br />The undersiqned hereby makes 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. ra-..,.k.. ei...f. . <br />Date Applicants Applicants Signature r� <br />Staff recommendation Approval Denial Date <br />CITY Reason for denial: <br />USE City Council Action Date Approve _ Denied <br />OMLY Date license mailed <br />