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;,Il <br />G :'�.`�:'l:.: I''S'I':•J.T,Li:S <br />� ♦ � c,l..t.�l •, r.�: ��•l:� LICIa:SI: A1'1'1.]Cit'1'lOII <br />IL,nr: 471-7757 <br />I <br />i All questions must be answered. License fee, bond, certificate of <br />insurance, and evidence of MPCA Certification 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 �, fle}_„san ro _ <br />2. Business address -n2,ox 3An <br />_ 55394 <br />3. Business phone 4z-€ 31 Residence phone 972_2420 <br />4. Name c_` applicant or company representative hQldina IIKA certifi- <br />J!m brque Ann " <br />catic:, Alfred Brregolmann <br />I5. Type of certification held: —Installer _Pumper <br />Site evaluator System designer <br />I CERTIFICATE NO. %3 <br />Is this a Provisional Certificate? — , <br />6. If no Certificate is held, provide evidence of attendance at one <br />of the Cn-Site Sewage Treatment Workshops held immediately prior <br />to the current construction season. <br />7. Have you ever held a Septic System Installer license in Orono <br />before? p,s Most recent year 1934 <br />8. Have you ever har: a license revoked? no When ? Where?_ <br />SUBMITTALS REQUIRED: <br />( _1. $25.00 license application fee. <br />jL2. $2,000.00 license and permit bond ;gaming City of Orono as <br />oblicee. The State Plumbeis Bond will not be accepted. <br />�., <br />3. $10-50-100,000 minimum Certificate of Insurance.i�� � - <br />4. 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 />LICEI4SES 1•:II.L NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED. <br />List persons other than applicant who are authorized by you to apply <br />for permits under your license j;mN {,f;,t,�r.t,•,,,�� <br />The vndefsilned he-eby wakes application to the City of otono. Minnesota, for license to install and <br />repair septic systems, and/or pump out septic tanks, subject to t►e la.s of the State of Minnesota <br />and the Ordinances of the city of Orono. <br />/�% <br />DailiApplicants signature <br />staff recommendation (Approva1•1W41C— l)vn1Jl: Date: 7. 1/• <br />Reason for denial: <br />City Council f.ctiur. t.tt.•:�—, - n;(•:e.•o.) ba•nir.d: i <br />OFFICE USI: ONLY <br />.te litany. :!• <br />