Laserfiche WebLink
I L <br />Scrap fetal De leriJunk DealerlRecycfiing operation License Application <br />Page 2 1 �pv�ned by applicant? <br />K Are �remises: Leased by applicant <br />If lea lsed: Name of ovmer <br />IBusiness address <br />Ili, PERSONAL DATA <br />A. Appi cant's Legal Name A <br />B. Resit ential Address <br />City State zip <br />C. Resi enti2l Telephone Number /F <br />D. SSN 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 />STORAG =-, AND LANDSCAPING. <br />V. INCLUDj, WITH APPLICATION, A $5.00 PROCESSING FEE <br />VI. AFFIRM ATION <br />1, hereby, Lertify and affirm that all of the information I have given in this application is true and <br />accurate t� the best of my knowledge. I further certify and affirm that I have in no way <br />attempted Ito mislead the City in this application by omitting facts known to me. I have read <br />and under Land the regulations of the Scrap Metal Dealer/Junk Dealer/Recycling <br />Operatio /Transfer Station license found in the City of South Bend Municipal Code, Section <br />4-51. <br />k D to <br />Sigrature <br />