Laserfiche WebLink
i u'h( %3J . 6: .l.)n <br />Crynud Tiny, MinnesoLs .',')323 <br />111111.1)ING R ZM NG — 473 357 <br />ASSrSSING <br />SVPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION <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 //�7 <br />(10) day approval period. <br />1. Business or trade name OlLi ell- /7i// co ._! r <br />2. Business address LOX ,_ (_ _ �/oot c <br />3. Business phone 7/0-71?116 Residence phone Sa- <br />4. Name of applicant or compan�( representative holding MPLA <br />certification j Ie. IQSTCr— <br />S. Type of certification held: Y, Installer Pumper <br />Site evaluator System designer <br />Is this a Provisional Certificate? CertificateNo. /Dqo <br />6. If no Certificate is held, provide evidence of attendence at <br />one of the On -Site Sewage Treatment Workshops held itranediatel <br />prior to the current construction season. <br />7. Have you ever held a Septic System Ir.staller license in <br />Orono before? ,« Most recent year �e� <br />8. Have you ever /had a license revoked? L1k— When? <br />Where? <br />�. Do you -10 Municipal Scwe,r hook-uns? Yes_ _ No <br />SUH,FTALS RED: <br />1. $2�. :e',se application fee.. <br />2. $2005 iccnse and permit bond naming? City of Orono as <br />oblige. The State Plumbers Bond will not be accepted. <br />✓ 3. $10-�0-100,000 minimum Certificate of Insurance. <br />,..� 4. Ccpy of current tiPCA Certifi ate or uvidence of attendence <br />at On -Site Sewage Treatment ►Jorkshop held immediately <br />n ri.or. to current construction season. <br />LICENSIS WILL NOT BE PROCESSED UNTIL ALL ITEMS ARE SUBMITTED. <br />List persons other than applicant who are authorized by you to <br />apply for pr-mits under your license <br />The undersigned he y ma —as application t*3 the City of <br />Orono, Minnesota, for license to install and repair septic <br />systems, and/or pump out sel.tic tanks, subject to the laws <br />of the State of Minnesota ail the Ordinances of the City of <br />Orono. <br />Date-/ ? Applicants Signature <br />Staff recommendat it i ApprovaO;(C Denial _ Date <br />CITY Reason for denial: <br />USE City Council Action Vate Approvr Den ed <br />ONLY Date license mailed <br />