Laserfiche WebLink
Scrap Metal Dealer /Junk Dealer /Recycling Operation License Application <br />Page 2 <br />K. Are premises: Leased by applicant owned by applicant? . <br />If leased: Name of owner <br />Business address <br />III. PERSONAL DATA <br />A. Applicant's Legal Name <br />B. Residential Address 1-2 3 s­b c� K Sb M <br />City �� �� 17 State r7 � Zip <br />C. Residential Telephone Number Z <br />D. SSN 1-t/ Z'Z- E_ Date of Birth �'I /'7 — 2 <br />IV. INCLUDE, WITH APPLICATION, A SITE PLAN OF THE FACILITY SHOWING <br />PROPERTY LINES, BUILDINGS, PARKING SPACES, LOADING DOCKS, FUEL <br />STORAGE, AND LANDSCAPING. <br />LVA <br />INCLUDE, WITH APPLICATION, A $5.00 PROCESSING FEE <br />VI. AFFIRMATION <br />I, hereby, certify and affirm that all of the information I .have given in this application is true and <br />accurate to the best of my knowledge. I further certify and affirm that I have in no way <br />attempted to mislead the City in this application by omitting facts known to me. I have read <br />and understand the regulations of the Scrap Metal Dealer /Junk Dealer /Recycling <br />Operation/Transfer Station license found in the City of South Bend Municipal Code, Section <br />4 -51. <br />i <br />Signature <br />l - Z 2 01-7 <br />Date <br />