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Scrap Metal Deale-/Junk Dealer/Recycling Operation License Application <br /> Page 2 <br /> K. Are pre t riises: Leased by applicant tl-�Owned by applicant? <br /> If lease c: Name of owner <br /> Business address <br /> 111. PERSONAL DATA <br /> A. Applicant's Legal Name <br /> B. Reside tial Address 2. 57-00 7—z e <br /> City c>L) Zt f IU a State 1 Zip <br /> C. Reside.tial Telephone Number > 2- Z-- <br /> D. S S N E. Date of Birth <br /> IV. INCLUDE, WITH APPLICATION, A SITE PLAN OF THE FACILITY SHOWING <br /> PROPERTYLINES, BUILDINGS, PARKING SPACES, LOADING DOCKS, FUEL <br /> STORAGE,LAND LANDSCAPING. <br /> V. INCLUDE, WITH APPLICATION, A $5.00 PROCESSING FEE <br /> VI. AFFIRMATION <br /> 1, hereby, ce�tify and affirm that all of the information I have given in this application is true and <br /> accurate tot oe 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/I ransfer Station license found in the City of South Bend Municipal Code, Section <br /> 4-51. <br /> Signature 15ate <br />