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i <br /> - F <br /> (tI <br /> ((7 <br /> F <br /> Scrap Metal Dealer/Junk Dealer/Recycling Operation License Application <br /> Page 2 <br /> / 3 <br /> K, Are premises: Leased by applicant ✓ owned by applicant? i <br /> i <br /> If leased: Name of owner j <br /> Business address <br /> i <br /> PERSONAL DATA <br /> A. Applicant's Legal Name <br /> e. Residential Address <br /> State Zip <br /> City <br /> 1 <br /> C. Residential Telephone Number l <br /> D. SSN <br /> F.Date of Birth E <br /> IV. INCLUDE, WITH APPLICATION, A SITE PLAN OF THE FACILITY SHOWING <br /> PROPERTY 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 /> I, hereby, certify and aff irm 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/.funk Dealer/Recycling <br /> Operation/Transfer Station license found in the City of South Bend Municipal Code, Section <br /> 459. <br /> i <br /> Signature Date f <br /> r. <br /> s <br /> J <br /> i <br /> Scanned by CamScanner <br /> i <br />