Laserfiche WebLink
1'u.t I If.., I�.. IA <br />(AITT of OKUNO <br />6UI I. DING A ZONING, - 4737357 <br />ASSESSING <br />7.1CLN. L III i:.I f: AT IUN <br />All questions must be answered. License fee, bond, certificate <br />of insurance, and evidence of MPCA Certification or -Home Sewage <br />Treatment Workshop attendance must accompany this application. <br />All applications are subject t��vol1 a/qE �_ten <br />��(10) day approval <br />" period. <br />1. Business or trade name /](CI NY 1N Wa x4"1 w4S*C <br />2. <br />Business <br />address <br />U,�q) <br />F,). LO <br />3. <br />Business <br />phone 47A-U343 <br />Residence phone =-,gye43 <br /><. Name of applicant or company representative holding MPCA <br />� certification _Vu (llt(Earh.i/ <br />5. Type of certification held: Installer _X Pumper <br />Site evaluator System designer <br />Is this a Provisional Certificate? Certificate No. <br />6. If no Certificate is held, provide evidence of attendance at <br />one of the On -Site Sewage Treatment Workshops held immediate <br />prior to the current construction season. <br />7. Have you ever held a Septic System Installer license in <br />Orono before? UrS Most recent year 'GPI,. <br />S. Have you ever had a license revoked? hO When? <br />Where? <br />aua 1]-Xa b "WOla v: <br />1. $25.00 license application fee. <br />�en,Q7✓2. $2000.00 license and permit bond naming City of Orono as <br />e 1>c obligee. The State Plumbers Bond will not be accepted. <br />1115van4 Vic. $10-50-100,000 minimum Certificate of insurance. <br />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 />LICENSES WILL NOT BE PROCESSED UNTIL. ALL ITEMS ARE SUBMITTED. <br />List persons other than applicant who are authorized by you to <br />apply for permits under your license <br />The undersigned hereby makes application to the City of <br />Orono, Minnesota, for license to inetall and repair septic <br />systems, and/or pump out septic tanks oubject to the laws <br />of the State of Minnesota and the Ordinances of the City of <br />Date <br />Applicants Signature <br />CITY Staff recommendation Approval V. Denial Date y <br />USE Reason for denial: <br />ONLY City Council Action Date <br />Date license mailed <br />