Laserfiche WebLink
11"... 0n <br />SEPTIC SYSTEM INSTALLERS <br />LICENSE APPLICATION <br />W )INGA %ONIN I:-:1 J./Jir <br />� I <br />_AT must be answered. Lice r.sc fw, bond, certif ica� <br />of insurance, and evidence of MPCA Certi`ic„tion or Home Sewa,i I <br />Treat:aent Workshnp attendence must acc^­,jany this application, <br />All applications � . sul)ject toga ten (10) day approval period. <br />1. tusiness or trad^ r ❑e /reca .••- <br />2. Business address <br />3. Business phone Z/ 77 ;idenc I,hone <br />4. Name ,c applicantoo company rep;esenL.- i•:�-, :�., Iding MPCA <br />certification ��/��..,, .7•__- <br />5. :;pe of certification held: y— Instala,r _ Pumper <br />Site evaluator jystem designer <br />Is this a Provisional Certificate?iy_ CertificateNo6/023 <br />6. If no Certificate is held, proviae evidence o: attendance at <br />one of the On -Site Sewage Treatment tlorkshops held immedir . <br />prior to the current construction season. <br />1. Have you ever he'.d a 'eptic . "Fc Inzsalcr license in <br />Orono beforea-�_ Mcjt rece: e<. r/ " - <br />S. Yaw you ever he a licer.sc When? _ <br />Fi,a re S <br />4 you do Municipal Sewer hook'.. Y � _ No <br />SUSMIT A.LS REQUIRED: <br />1. $25.00 license applicr• <br />i. $2000.04 license and <br />^bligea. The State <br />I. $11-50-100,000 mini; <br />a[ 4. `opy of current MP-, <br />..t On -Site Sewage.••r <br />prior 'I.rrent cc <br />le4. y' 9 ,3. <br />nq City of Orono as <br />all not be accepted. <br />of Insurance. <br />-.s nt evidence of attendance <br />neld ixa diately <br />u:. eei:.r:. <br />LI:EGSES WILL `IOT BE PROC?f'ED UNTIL ALL ITEMS ARE SUoAlTTED. <br />ist perscns other than applicant who a autho�l$ed by you tq <br />s,I,.y for permits irder lour .ices 1l_= .... <br />The und.,reigned hereby makes application to tne city of <br />Or, Minne L. ta, for license to install and repair septic <br />sy, .s, and/cr pusp cut septa. -anks, subjoct to the laws <br />of the S ati of M nnosota and the C--d.nanc:s of the City of <br />Orow <br />Ds to Appltca,.ty . ignature-..C.L�_ - ►,_ <br />S,.aff :ocoswt^da. on Approval _ [4. r.L1 _ DaU3�$> <br />CIiy Person for denial: _ _ <br />USE C1•: Council Action Date A <br />ONLY Da a 1;!enee , d — PProvc -_ t��- <br />