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Scrap Metal Dealer/Junk Dealer/Recycling Operation License Application <br /> Page 2 <br /> K, Are premises: Leased by applicant —� owned by applicant? <br /> If leased: Name of owner � o(,2 l U- I LL(I <br /> Business address --- �a�-Ph EEO) <br /> Ill. PERSONAL DATA / <br /> A. Applicant's Legal Name ' 64 tl�i ILO /&�? <br /> B. Residential Address <br /> City 1) �� �� , �J! State To zip <br /> C. Residential Telephone Number 06,6 <br /> D. SSN 3-� aL 17 21�- -- E. Date of Birth I a bg a <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. , '�, nvi 4te, <br /> V. INCLUDE, WITH APPLICATION, A $5.00 PROCESSING FEE <br /> VI. AFFIRMATION <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 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 /> Signature Date <br />