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t trt•t... t..; LICE;;}; i+i i'.,.t ..'i'1(l;: <br />All yues: ions rlu!;'. be an!, crec}. Liccni:C fee, bond, ce_•tificate of <br />insurance, and ev ' .r_ r Of 1•11'CA Certification or }come Sew,: ge <br />ment htolkshop a'. te.,,an�e must accompany this ,replication. All appli- <br />cations are subject to a ten (10) day appro._1 period. <br />'JJ � <br />1. Business; or trade na:.ie <br />1 y V T �..J, .L.✓:- <br />2. Business a:djres J^ S1i� j <br />7-�y� �H J�A�f t ko- `c!s: �itk� k-7 <br />3. Business phone --'ZZL(f--VV Residence phony <br />4 . Name cf apF iC;.'?t Or cOm!'.:;1,: i'e; :CSe tat; �3012; aYjPCh cer' f I <br />5. Type of certification thold: Xinstaller Pumper <br />i <br />ISite evaluator System designer <br />Is this a Provisional Certificate? CERTIFICATE vO. <br />6. If no Certificate is )Ield, provide evidc,,;.t of attendance� a t one <br />jof the Or. -Site Seti•:ace Treatment V'Orkshcps held ir",ediately prior <br />j to the current construction seasc:,. <br />7. Have you ever held a Septic Syste:,, Installer license in Orono <br />before? � _ Most recent year <br />8. Have you ever had a s_ r r I license e�c..er''�l•;hen-:- __-lahere? <br />SUBMITTALS P.£QJIs`,EL:--------- - - ---------------------_...—....._ _�...._ .! <br />`� 1 • $25.00 license application is . 1 + ' y <br />2• 52,000.00 license and permit bond naming City as <br />obligee. The State Plumbers Bond will not be ac. <br />3• $10-50-100,000 mini --um Certificate of Insurance. <br />COPY of current MPCA Certificate or evidence of attendance at <br />On -Site Sewage Treatment Workshop held immediately prior to <br />current construction season. <br />LICENSES ]•;ILL NOT BE PROCESSED UNr1L ALL ITEMS ARE SUBMITTED. <br />List persons other than applicant who are authorized by you to apply <br />r permits under your licer.;c <br />:he under:i5nee heret. 1-.akes a,rt to the e... f)rono. Minnesota, for license to ]natal] and <br />repair septic systit.1. and/or It, <;.t septic tar t to the laws of the State of Minnesota <br />and t� Ordinances of the (,: otono. <br />Date- ' �K,L--4, / 1 A <br />-�- / pplicants signaturei.4A) <br />5141f reconnehiation Approval: <br />Reason for eenial: <br />Denial:— _ Dater <br />tJ counci) ..•item Oat,:__-. ai;ar.rrJ Wr.:,a <br />:atn I,c..r.-. <br />OFFICE U!:;: 0':11,'i <br />