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CITY' ®f ORoNo <br />Crynlal It.,. Minnennln calm <br />IIIDLDING a ZO.%INI; - 4139I57 <br />'W"SING <br />SEPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />All questions must be answered. License fee, bond, certlticate <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 />1. Business or trade name <br />2. Business address , <br />3. Business phone Re-idence phone <br />4. Name of applicant or company representative holding MPCA <br />certification 1.1 11 .. <br />5. Type of certification held: Installer Pumper <br />Site evaluator System designer <br />Is this a Provisions Certificate? I•: Certificate No._ <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 held a Septic System Inst ller license in <br />Orono before? 1_ Most recent year <br />8. Have you ever had a license revoked? JWhen? --' <br />Where? - -. <br />4. Do you do Municipal Sewer hook-ups? Yes_ No ' <br />SUBMITTALS REQUIRED: - - - <br />1. $25.00 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 />..5 t�. w•II Sn $10-50-100,000 minimum Certificate 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 <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 Ordin¢nces of the City Of <br />Orono. % <br />Date �` Applicants Signature 1/ T�• +�rC -r` <br />Sta££ recommendation �Approval'�/Y( Denial ` Date <br />CITY Reason for denial: <br />USE City Council Action Datc Approved De <br />ONLY Data license mailed <br />