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Arl`Y (lf :AU }N \ } ' •'.. ..., • ,. :c i : ;;� , . . i:�� 7 �:1,•;•f,l.I,t:i;:; <br />t•,y..,, �•. :. L7Cl:t�Sl: i`l,]Crt'1'101' <br />i:11 yuc!-:t1 <br />0n : n:ur,t be -111 rctl. Licen-•c fee, bond, certificate of <br />insuranct, rind eviOcnce of 1.111CA Certification or Home Sewace 'Treat- <br />ment Vorl:--hop atte.4t3.';11ce must accompany this application. All appli- <br />cations are sub;ect to a ten (10) day approval period. <br />r <br />1. B u s i n e E• s or trade name + f Kj <br />f <br />2. I:vslncss i:ddre!ls /11 r <br />3. Business phone •/2j- ,5-y7 Residence phone <br />;i.CO+ :'r+O1C]+C1iI'CiCt.1 Cr i::_11ci:at Or erl 1- <br />17 <br />I 5. Type of certification held: In,taller i Pumper <br />_Site evaluator A System desicner <br />!; i a aCertificate') CERTIFICATE NO. <br />I s t <br />Provisional _ �, <br />lS. If no Certificate is held, provide evidence of attendance at one <br />of the 0:-t-Site Sewage Treatment 1•;orksheps he-'d i;r_-,ediately prior <br />to the current construction seaso-n. <br />7. Pave vow ever held a Septic Syst-cm Installer license in Orl".)0 <br />befo_-C., pe, _ 1•;ost recent year 1 �l <br />8. Have , cu ever had a license revol:cd?_i;re^? 1•:here - <br />Sum':=TT..L-S ..:QUIF,::D.----•---------------- --_- _-------.."._ -__ .. __... <br />CC 1. $2.5.00 license application fee. <br />ek-_.2. $2,000.00 license and permit bond naming City of Orono as <br />oblicec. The State Pluniters Bond will not be accepted. <br />oL 3. 510-50-100,000 rtinimum Certificate of Insurance. <br />C1 _ 4 . Copy of curren• 1•,r'CA Certificate or evidence of attendanc <br />On -Site Sewace Treatment Workshop held iflmmedi :tely prior <br />current coltst:ruction season. <br />LICENSES 1•,ILL NOT BE PROCESSED UNTIL ALL I:'EMIS ARE SUBMITTED. <br />List persons other than applicant who are au' -red by you to apply <br />for pernits under your license <br />The undc•raiSned IK•rchy tsales a;.pltution to the City of Oronc. Msnnesota, for license to install <br />repair Septic systems, Arid/of pump out septic tant., t.biect to the lays of the State of :11nnesota <br />and the Ordinana.s of 0W City of Orono. <br />Date - (- - '� y / <br />-- �- .—_..� Applicants s,, , .cure' .��� / /r✓i�._.... == '"`_ <br />Staff reccn,^ na!etia.n Apl.rov,l: )r Denial: Date. <br />Reason for <br />it/ Cow,cil .` tc:. L..t..-.__.,_______. - h==�t,.•eJ:—� _ Drr.:..,; <br />,,t.,•.. -- --- — OrrICr usi. Olrl,Y <br />