Laserfiche WebLink
II `_ O!!,ert, at: lea'. ri:l"1'1c �1��.� I;. �,ji•1.1.7:1�ri <br />f (1) Ito N r., .�: r: , <br />r..ry. r:•: ,'•3:3 LICL;:Si: AP1'I,ICi+T1U;: <br />r,... iw: 471-7357 <br />All questions must be answered. Licenre fee, bond, certific,,tc: of <br />insurance, and evidence of MPCA CertifiCC.tioll or Home Sewage Treat- <br />ment Workshop .attendance must accompany thin application. All appli- <br />cations are subject to a ten (10) day approval period. <br />1. Business or trade name cV','.LTVAN'F crRVTCFF TNC. <br />2. Business address 3C.frCI HIC, I��'r.Y Ill "ZOU111. 1.-AY!AV tiI13, — <br />3. Business phone 473-4300 Residence phone 471-IRSn <br />i <br />4. Cf applicant or company representative holdino MPCA Certifi- <br />j CaLic:'+ <br />5. Type of certification held: .nstaller Pumper <br />X Site evaluator X System designer <br />Is this a Provisional Certificate? NO CERTIFICATE NO, nO77n <br />6. If no Certificate is held, provide evidence of attendance at one <br />of the On -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? YcC Most recent year l(2A!, <br />8. Have you ever had a license revoked? NT when? Where? <br />SUBMITTALS REQUIRED.. <br />QL4 1. $25.00 license application fee. <br />2. $2,000.00 license and permit bond naming City of Orono as <br />obligee. The State Plumbers Bond will not be accepted. <br />f �L 3. $10-50-100,000 minimum Certificate 1 : I•-surance. <br />Copy of current MPCA Certificate e,. evidence of attendance at <br />On -Site Sewaae :reatment Workshop held immediately prior to <br />current construction season. <br />LICENSES ':LL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED. <br />List per,ons other than applicant who are authorized by you to apply <br />for permits under your lice: ����IlccxlT JQ1; ;`_��r OR LFy\I$ k'C)I.TF'RE <br />The undersigned hereby tykes applicatiot. 10 the City of Orono. MinnesOta, for license t- install and <br />repair septic systes+t, and/or puwp out septic tanks, subject to the laws of the State of Minnesota <br />and the Ordinances of the City of Orono. <br />Date 3/20/85 Applicants signature <br />Staff tecomaendatlon 16pproval: venial: Cater <br />Maton for da•nial: <br />Clty Council !.!tir.n L.it.. A-pr <br />Late lick!­ <br />..,,i.. — OFFICE USI: nNLY <br />