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'age 2 <br />applfcant owned by appiicant? <br />E-L('vness address To <br />Ill. PERSONAL DATA <br />A Applicant's Legal Name <br />B. Residential Address X�A <br />City ko( <br />State <br />C Residential Telephone Number <br />D SSN E. Date of Birth <br />IV. INCLUDE, WITH APPLICATION, A SITE PLAN OF THE FACIL-ITY 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 />1, 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 />A <br />P <br />Date <br />