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V-1 111111 .. . ... . .... <br />CITY <br />C".41 IbY. Mi., !.SYYI <br />IMILMNG A ZONING - 4739157 <br />ASSESSING <br />SEPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />11 questions must be answered. License nee, bond, certificate <br />.f insurance, and evidence of MPCA Certification or Home Sewage <br />reatment Workshop attendence must accompany this application. <br />All applications are subject to a ten (30) day approval period. <br />1. Business or trade name LL)r S{CI, IICA Sf ww s 1.A.'AC <br />2. Business address (,SDI CC, iLd 15. MUD 1 /177 SS3(of/ <br />3. Business phone L411-LN(0(0 Residence phone N7A-4040 <br />4. Name of applicant ofF //commppa�ny reppresentative holding MPCA <br />certification ke 14-bt C_L/}.t I <br />S. Type of certification held: ✓Installer _ Pumper <br />Site evaluator System designer <br />Is this a Provisional —Certificate? QQ Certificate No.q_U <br />6. I£ no Certificate is held, provide evidence of ette M <br />one of the On -Site Sewage Treatment Workshops held'! el �, OD <br />prior to the current construction season. <br />rA&K R p.00 <br />7. Have you ever held a Septic System Installer licensdFMT-141A rou <br />Orono before? ?? Most recent year JqJ7-kt #084830 EXI,k01 T}4111 <br />8. Have you ever had a license revoked? L When? %16/88 <br />Where? _ <br />0. Do you do Municidal Sewer hook-ups? Yes No <br />SUBMITTALS REQUIRED: <br />1. $25.Or license application. fee. <br />2. $2000.00 license and permit bong naming City of Orono as <br />obligee. The State Plumbers Bond will not be accepted. <br />3. $10-50-100,000 minimum Certif..-c ce of Insurance. <br />4. Copy of current MPCA Certificate or evidence of attendance <br />at On -Site Sewage Treatment Workshop held immediately <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 i391A1 L1.MIIC SI"c<I4tc.1A„00H14L <br />The undersigned 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. Date -IO.%D �/ kkApplicants Signature s/t'lu( S1- r/1, �P'V" <br />CITY Staff recommendation Approval Denial _ Date <br />USE Reason for denial: <br />ONLY City Council Action Date Approved Denied <br />Date license mailed __ <br />