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S cr,.a:, P, M eta i <br />Page 22, <br />K. <br />Dealer/Jijnlrk Dealler/Recyding Operation License Appl cation <br />Are premises: Leased by appkant owned by applicant? <br />If ]eased: Name of owner <br />Business address <br />PERSONAL DATA <br />A. Applicant's Legal Name <br />B. Residential Address <br />City State zip <br />C. Residential Telephone Number 1237— <br />D. SSMINOWNIMEW—, E. Date of Birth <br />IV, INCLUDE, WITH APPLICATION, A SITE PLAN OF THE FACILITY SHOWING <br />PROPER TY 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 />4-51. <br />7" Date <br />Signature <br />