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CIr1.1, ()f' ")1i()N0 <br />I C J .'1,1,... <br />c�l:t.�i r.,., ... 1.ICLN I APPLICATION <br />r:.m-e : t ; l - 7 i„ <br />All questio.)s mutt be answered. License fee, bond, certificate of <br />insurance, and evidence of MPCA Certi'ication or Home Sewage Treat- <br />ment Workshop attendance must accompany this application. All appli- <br />cations are subject to a ten (10) day approval period. <br />1. Business or trade name .4 ( oA. Bites. SCeu .-K 4- c,r•'97—zk <br />2. Business address /6 S R;Q6 c 'n't- X00w <br />3. Business phone ZO - 379 '3 Residence phone �•h� <br />4. Name c< a.,r.l icant or 1—eoresentative holdinc I•;pCh. certif i- <br />i <br />I5. Type of certification held: Installer Pumper <br />Site evaluator System designer <br />I CEFTIFICieTE 1,10. DD <br />Is this a Provisional Certificate?L, <br />I 6. If no Certificate is held, provide evidence of attendance at one <br />of the On -Site Sewage Treatment 11orkshcps held irmiediately prior <br />to the current construction season. <br />7. Pave you ever held a Septic System Installer license in Orono <br />before? c' S Most recent year i 7 fry <br />rave you ever had a license revo):ed?&�When - Where? __ ! <br />SUBMITTALS ?EQUI::ED. ____ .-•------------ -- __�...__..-•------..._ .' <br />Or,1. $25.00 license application fec. �`QCve.'() <br />2. $2,000.00 license and permit bond naming City of Orono as r­" �, I <br />Obligee. The State Plumbers Bond will not be accepted. <br />,It 3. $10-50-100,000 iiinimum Certificate of Insurance. <br />(h 4. Copy o: current MPCA Certificate or evidence of attendance at <br />On -Site Sewage Treatment Workshop held immediately prior to <br />current construction se- in. <br />LICE14SES 1-.ILu NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBM`TTED. <br />List pc_-ons other than applicant who are authorized by you to apply <br />f^" permits under your license � F A75—v.p`� <br />The undersigned hereby sakes application to the City of Orono. Minnesota, for license to install and <br />tepalr septic systems, and/or pump out septic tanks, subject to the laws of the State of Minnesota <br />aqd the Ordinances of the City mono. <br />Appliconts signature f <br />"if reeoseaendation Approval: Denial: Date:_ <br />Reason for denial: <br />City Council Actitm Lat.• - -- R hijtt,vcJ: brn:rd: <br />Cate C'!'I'IC% US-, 0.7L'i <br />