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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 �"? K ^ <br />Business address 'A- Nyu• 0f?_LPrb 1Per_� =, L <br />III. PERSONAL DATA , ^ <br />A. Applicant's Legal Name <br />B. Residential Address l ct G Mi e_4A,0 `7_-A,_ gh <br />City "Rky�bz State zL Zip <br />C. Residential Telephone Number —7 L4 L4_7 _ I LI (61 <br />D_ 5SN 33`— (02_ 1�t5 E. Date of Birth <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 />V. 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 -59. <br />Signature <br />1- l3 —Zf l-7 <br />Date <br />la <br />