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,g 0�o pp[3ICat0 s <br />^v " sf Scram'Metal Deale -/Fu e O e G { � � <br />Page 2 <br />K. Are premises: _ __ __ <br />Leased by applicant owned by applicani? <br />If leased: name of owner <br />Business address <br />M. PERSONAL DATA <br />A. Applicant's Legal name _ <br />- <br />B. Residential Address �-° <br />State � i °L c4 Zip <br />� <br />City <br />C. Residential Telephone Number <br />D. SSi`i _ <br />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, ORACLE, AD LANDSCAPING. <br />V. INCLUDE, WITH APPLICA T ION7 A $5.00 PROCESSING FEE <br />VI. AFFiRMAT10N <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 omitting <br />lerl��R� �ealerlRecycl ghave read <br />and understand the regulations or the Scrap Metal <br />Operation /Transfer Staftn license found in the City of South Bend Municipal Code, Section <br />4-51. <br />Date <br />SignatL[re <br />