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Scrap ;metal Dealer/Junk k Dealerlll \erJ�,din Operation License Appflcatier� <br />Page 2 <br />K. Are premises: <br />Leased by appiicant owned by applicant? <br />if leased: Name of owner <br />Business acidness <br />III. PERSONAL DATA <br />A. Appiicani's Legal lame � %� �`� � <br />��, +� v <br />B. Residential Address <br />City Y u �,. /'vim <br />State Zip tJ G i <br />C. Residential Telephone Number <br />D. SSN <br />E. mate of Birth el—l— 19Y3 <br />IV. INCLUDE, WITH APPLICATION, A SITE PLAN OC FA®IIN ®O SI FUEL <br />PROPERTY LINES, BUILDINGS, PARKING SP ES <br />STORAGE, AND LANDSCAPING, <br />V. INCLUDE, WITH APPLICATION, A $5.00 PROCESSING FEE <br />VL 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 />Dl <br />anid understand th e regc I at�oiis n� the c�- Arll ur. Dealer/Recycling <br />Operation /Transfer Station license found in the City of South Bend Municipal Code, Section <br />4 -51. <br />I l Late <br />ignature <br />