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OR <br />NO Cryewl R.Y. Minne�nm G4TL7 SEPTIC SYSTEM INSTALLERS <br />('Airyof O <br />N_ VY u`� hICENSE APPLICATION <br />aU1tDINGA MWING-.A34357 <br />ASStSSING <br />All questions must be answered, License fee, bond, certificate <br />of insurance, and evidence of 14PCA Certification or Home Sewage <br />Treatment Workshop attendence must accompany this application. <br />All applications are subject to a ten (20) day approval period. <br />1. Business or trade name 1 �f�(i')'m Iq 4-YI jo].IJL4 <br />2. Business address 61 X1111iy Y1cI/aL' <br />3. Business phone CI T )L-7��I Residence phone <br />4. Name of applicant nr party ,p resentative holding CA <br />certification YI ( 'L 16� S�Ve�(r „(.i <br />", T� <br />5. Type of certification held: 1,/Installer Pumper <br />Site evaluator System desiy..er <br />Is tthis a ProvisionarCertificate? Certificate No. 23' <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 />rono before? V", Most recent year <br />S. Have you ever had a license revoked? �il_ When? <br />Where? _ <br />4. Do you do Municipal Sewer hook-ups? Yes i 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 />72 obligee. The State Plumber. Bond will not be accepted. <br />3. $10-50-100,000 minimum Certificate of Insurance. <br />q_ 4. Copy of current MPCA Certificate or evidence of attendence <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 ( C,4-t <br />The undersigned hereby 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 />of the State of Minnesota and the Ordinances of the City of <br />Orono. <br />Date Applicants Signature <br />CITY Staff recommendation)(Approval &�" Denial =Date <br />USE Rcason for denial: <br />ONLY C.Ay Council Action Date Approve Denie <br />Date license mailed <br />