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CITY of ORONO """'a1ism <br />SEPTIC: SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />RVII..)INGa ZONING-B]JS51 <br />ASSESSING - All questions must be answered. License fee, bond, certificate <br />of insurance, and evidence of MPCA Certification or Home Sewsige - <br />Treatment Workshop attendance must accompany this applications., <br />All applications are subject to a ten (10) day approval period. _- <br />1. Business or trade name C-&utr <br />2. Business address at_ t.•'L_ 37 Z [a...0 iy 5r3?0 - <br />3. Business phone 6 i T - YY 3 ( Residence phone Sce ) C. <br />4. Name of applicant or company representative holding MPCA <br />certification 5.,.., ?asie,- <br />5. Type of certification held: '_ Installer _ Pumper <br />Site evaluator System designer <br />Is this a Provisional Certificate? g( Certificate No. to yo <br />6. If no Certificate is held, provide evidence of attendance at <br />one of the On -Site Sewage Treatment Workshops held immediate <br />prior to the current construction season. <br />7. Have you ever held a Septic System Installer license in <br />Orono before? ,may_ Most recent year 81 <br />8. Have you ever had a license revoked? IA� When? <br />Where? _ <br />9. Du you do Municipal Sewer hook-ups? Yes yts 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 />_ 3. $10-50-100,000 minimum Certificate of Insurance. <br />4. Copy of current MPCA Certificate or evidence of attendence <br />at On -Site Sewage Treatment Workshop held immediately <br />prior to current construction season. i:xf' I' �, <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 Ordinances of the City of <br />Orono. n <br />Date - 8 Applicants Signature <br />Staff recommendation, Approvals_:\_ Denial _ Date <br />CITY Reason for denial: <br />USE City Council Action Date Approve Denied <br />ONLY Date license mailed _ <br />