Laserfiche WebLink
c�ga.,3 e.,y. .... ;t?:I S.IC1"ISE APPLICitT101F <br />Phone. e7]-7);7 <br />All <br />questions <br />r:ur t be 1nst..Cred- License fee, bond, certificate of <br />insurance_, <br />and evidence of MPCA Certification or Home Sewage 'Treat- <br />ment <br />Workshop <br />attendance must accomp,:,1,, this application. All appli- <br />cations <br />are <br />subject to a ten (10) day approval period. <br />1. <br />Business <br />or trade name bo-e a4-mlICA- <br />2. <br />Business <br />i:ddrens GS0I Cc--, a.4 I 1nk[c'J«c( lti,N 53 <br />3. <br />Business <br />phone �7Z — ClUG, Residence phone <<7t4. f oc <br />Name or <br />i <br />apr�lic� nt .orecomra;�y rct�resentrtive } olcina <br />vatic: <br />5. <br />Type of <br />certification held: ✓fnsLall.er Pu;,:per <br />j <br />Site <br />evaluator System designe• 9, <br />i <br />Is this <br />a Provisional Certificate? CERTIFICATE N0. <br />G . <br />If no Certificate <br />is held, provide evidence of attendance at one <br />i <br />of the On -Site Sev,„� <br />age Treatment Worf•.shc- hel,? imediately prior <br />to the current <br />construction season. <br />7 <br />Have �o,l <br />v ? 1 ' <br />• ) e er it: a a Septic System Installer license in Orono I <br />before? trO*"— h;ost recent year_/ 13 <br />8. Have ,,,ou ever had a license revoked? N/O When?t:he:e? <br />SUB}ITT..LS Pr ---... - .._....---._._... <br />v/ •..C�UI:�ED: <br />$25.00 license application fee. <br />2• $2,000.00 license and p- --it bond naming City of Orono as <br />obligee. The State Plum. s P..cnd will not be accepted. <br />3• 510-50-100,000 riinimum Certificate of Insurance. <br />Copy of current MPCA Certificate or eviderce of attendance at <br />On -Site ^wage Treatment Workshop he:' imfrpdiately prior to <br />current construction season. <br />LICENSES E'ILL NOT BE PROCESSED UNTIL ALL ITE14S ARE SJRNIITTED. <br />List F/^rsons other than aNplicanc who are authorized by you to apply <br />for Permits under your liter ��- ('Cep - � „" C `/�..&- 14„},:C r— <br />The undcrs:yr• hc,cby awkcs app:iCation to t..e City of Orono, Minnesota, for license ►v inst4ll and <br />repair Septic systcms, and/or pump out st.ptic tabks• subject to the Is's of the State of Minnesota <br />and tt,e Ordinantts of the City of Orono. <br />Applicailts si•Ina. .re <br />staff tec4.+-.,end, ,roYJ3: C k <br />Reason for �lh •i' <br />t/ Catnt,l ', t <br />.,• � �•. /.{. rc,rc•. to <br />S,at! Stct,. .. , .::. 'CFI ICI:. USF: ONLY <br />