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4ITYof OR NO e.r..13.y. 7A mom a72521 <br />SEPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />SUILPINGA 7Oh LN(, - 473.7337 <br />ASSESSING <br />All questions must be answered. License fee, bond, certificate <br />of insurance, and evidence of NPCA Certification or Home Sewage <br />Treatment Workshop attendence must accompany this application. <br />All applications are subject to a ten 110) day approval period. <br />1. Business or trade name "n1'.tCLJ Cr'A+-0C�'l, <br />2. Business address HNO ME !2�" 6K P Wof M0 55330 <br />3. Business phone N(4)-'icy`" Residence phone 14L11"4Cu`3 <br />4. Name of applicants or comppny representative holding MPCA <br />cextification L)l rtnr- N0.htn cl <br />5. Type of certification held[ Installer _ Pumper ' <br />Site evaluator System designer <br />Is this a Provisions Certificate? _ Certificate No.L k4 <br />6. If no Certificate is held, provide evidence of attendance at <br />one of the On -Site Sewage Treatment Workshops held immmediatel: <br />prior to the current construction season. <br />7. Have you ever held a Septic System In gaper license in <br />Orono before? �Most <br />, recent year ] !SS <br />8. Have you ever had a license revoked? 6 When? <br />Where? _ <br />4. Do you do Municipal Sewer hook-uds? Yes V, No <br />SUBMITTALS REQUIRED: <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 Bond will not be cccayted. <br />3. $10-50-100,000 minimum Certificate of Insurance. <br />.7'4. Copy of current MPCA Certificate or evidence of attendance <br />at On -Site Sewage Treatment Workshop held immediately <br />prior to current construction season. <br />- <br />WILL NOT <br />BE PROCESSED UNTIL ALL ITEMS ARE <br />SUBMITTED. <br />- _LICENSES <br />List persons other <br />than applicant who are authorized <br />by you to <br />apply for permits <br />under your license �- .., •. ��i'ie <br />a-f <br />The undersigned <br />hereby makes application to the <br />City of <br />Orono, Minnesota, <br />for license to install and repair <br />septic <br />:1 <br />systems, and/or <br />pump out septic tanks, subject <br />to the laws <br />!� <br />of the State of <br />Orono. <br />Minnesota and the ordinances of <br />) <br />the City /of <br />'l <br />Date <i-of-U..' <br />Applicants Signature (7 'U.tt <br />.i ✓!-�/f'� <br />Staff recommendation Approval K_ Denial _ Date 7-Vs' .7lr <br />CITY Reason for denial' _ <br />USE City Council Action ❑ate Approv_ d _ Denied <br />ONLY Date license mailed _- <br />