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CITY of ORONO t,ryottal flay, Minnexota F632-1 <br />SEPTIC SYSTEM INSTAi,LERS <br />LICE14SE APPLICATION <br />Utill l)IN(; A JONING - 473 7357 <br />ASSLSSING <br />All questions must be answered. License fee, bond, certificate <br />of insurance, and evidence of MPCA Certification or Home Sewage <br />Treatment Workshop attendence must accompany this application. <br />All applications are subject to a ten (10) day approval period. <br />1. Business or trade name IngleLdde Enginezrllli; G'�rnst., inc. <br />2 . Business address H' # 1, iJ: x17' inn. 55373 <br />3. Business phone b12 11;7 , tcb',, Residence phone 612 LT 2'iLl <br />4. Name of applicant nr company representative holding MPCA <br />certification nn i-_rruzht <br />5. Type of certification held: _ Installer Pumper <br />Site evaluator System designer <br />Is -his a Provisional Certificate? lip Certificate No. <br />6. If no Ce-'_ificate is held, provide evidence of attendance at <br />one of the On -Site Sewage Treatment Workshops held immediately <br />prior to the current construction season. <br />7. Have you ever held a Septic System Installer license in <br />Orono before? Most recent year <br />S. Have you ever had a license revoked? When? <br />Where? <br />Do you do municipal Sewer hook-ups? Yes No _ <br />SUBMITTALS REQI,'IRED: <br />1. $25.00 license application fee. <br />2. $2000.00 license and permit bond naming City of Orono as <br />obligee. The State Plumbers Band will not be accepted. <br />3. $10-50-100,000 minimum Certificate of Insurance. <br />4. Copy of current MPCA Certificate or evidence of attendence <br />- - at On -Site Sewage Treat -merit Workshop held irrsnediat.ely <br />prior -o current construction season. <br />LICENSES WILL. NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED. <br />c� <br />` — List persons other than applicant who are authorized by you to <br />Or: apply for permits under y-ur license <br />The undersigned her0)y makes application to the City of <br />'__--- Orono, Minnesota, for license to install and repair septic <br />systems, and/or pump out septic tanks, subject to the laws <br />M of the State of Minnesota and the Ordinances of. the City of <br />Orono, r <br />Date ter. Applicants Signature lY „ <br />Staff-ecommendat-ion Approval —- Denial L�- '� •_ <br />CITY Reason for denial: <br />USE. City Council Action pzte � Approve cl � _ Donied <br />ONLY Date license mailed _ <br />