18-10 Scrap Metal License Approvals

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, f I r 4 iNDIANA SECRETARY OF STATE ZONING AFFIDAVIT AUTO D!_ALER$ERVICES DIVISION - Slate Form 55936(11-15) i "l02 West Nashington Street.Rraon,E-010 y Indlanapolis,IN 46204 1 De<3ierssr;os.in.gav {( f=ax.1,317)233-1915 i E 4 INSTRUCTIONS: 1.Complete in blue or black ink or print completed of iidavil- 2.Section f must be completed by the applicant. 3.Section 2 must be completed by the zoning official Wth)arisdiction over the desct ihed rear propnrtt: It no person or officer has jurisdiction,the applicant must submit a written statement by the axectrtve of the u,'tit in which the real property is located indicating that the proposed location is zoned for the operation of the business too,whWi the rlpplirant seeks a license. 4. The completed affidavit must be mailed,taxed,or emailed to the Indiana Secretary o?Slate Auto Deatur Services Division. Your a license application cannot be processed until a completed affidavit or written stalertxlnt is received. -1N a, •.i+e:•. ut,.,,., .•y..-. a3'aY.'.+2s..aE.ci•'.r.: - - - - ::'tY: -.;�: "•;;,. - ..'s3�": cx...,k r.:- �. ,1. : �SEGTEON-9-''I'QE3E_:;vt? is Yn,' D�BY<.tQf'i?LE�t�P,E � ?' i''�' -mss;--•, •,:::sy;.t_„•<c Namn'in which the Deal:1' nse will be issued(Doing Business As(013A)rsnw) Lage.i name of the b.,sinnss 21P cote County q' Stree dress(Proposed a nois LocallowAnumber and sheoy Comity, F CJ�'�f �1 I t.__-L=;�`Y _l3'�C—;t-...____--'�lZ.! I t ! •�, i gLicense Type ❑ Automobile Auction ❑ Converter Maixlracturer ;] 141anufactu°ear El Automotive Mobility El New or Used Dealer [J Transrr CS Automotive Salvage Recycier ❑ Di.stnbutor ❑ Waledcmft Type of Activities to take place at the location --` — (Check all that apply.) @ ❑ Selling new and used vehicles ❑ SeHiny rrotur vehicles W dealers 9zc2te3 is+.frdiana as s distributor St ❑ Selling used vehicles w\'recking or d3smartling vehicles$u resalo of th--ir major,;anponrnt Ps9t$. a ❑ Selling MotorcyciesiMotor Driven Cycles ❑ Rebuik+ing saivage,wrecked o,d:smamial v?notes ❑ Selling WatercraltMatercraft Trailers ❑ Disposing of rxy°:IaSle materi:lts to a sc..ap n:etai pracesarr of eUrer app:apriate facility ❑ Selling Trailers ❑ Adding to,subtracting from.rr"K dry;'c z rrc rnusy assemb,ed motor vahkie ❑ Selling ATVAITVISnowmobiles ❑ Providing 2 facrii:y for the purchase and+salt of motor vehcles nn the basis of bids(Auction) ❑ Selling RVs ❑ Manufauunng or assembling new mrxo-venwiss or mafor component parts ❑eling Manufactured Homes ❑ Possessing hvo(Z)ct more iiwerattn.•ehrtes scircrt to tagisiration to:more than Wiry(30)days ®'Soiling used major component perLa of vehicles ❑ Selling adapted vehicles ❑ fngagn,y in ii:a bsi,:us of stcrKlg.di;:r�.,vng.saivaymg or,eey:aing of vehicles,vehicle hWks or the parts Vf VW 60s ❑ We TtansterlFinancial InstikMonlinsurance 3 Company g Zoning(select one of the ronolving.) --°— _...__._.--_ ----•-- --- -• 111I q �I ❑There is a person or official charged with enforcing zoning ordinances for the above described¢-loimiiy irnusl compute Section 2). ❑There is no person or official charged with enforcing zoning ordinances for the above described property(Whist sriamil a tvrftter,statement as described in instruction#3 above). a thereby certify,under the penalty of perjury,that i am authorized to make this 2ppliraUon and that the answers and infonmaiion contained in this application are true and correct. E Signature of Appl' Date Sig.ed(mrrJ/M y) du SECTION 2-TO BE COMPLETED BY•ZONING OFFICIAL I,the undersigned,swear or affirm without stipulation that the above describes(property complies with local zoning ordinances or other local ordinances for the type of business indicated above. E understand that making a false statement I ! may constitute the crime of perjury. --� pSignature of Zoning official — ti 1.3110/2 01 i Printed Name of Zoning Official t T:Ve i Ayoka Paek Zonin 8. Busittevs Services Administrator] Authorizing Agency _ St.Joseph County/South Bend Building Department s i t 1