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^ <br /> INCLUDE, Susinassaddress <br /> D, SSM E, Date of Birth <br /> IV. INCLUDE, WTH APPLICAT[ON, A SITE PLAN OFTHE FACILITY SIIHIOWING <br /> PROPERTY LINES, BUILDINGS, PAR't"UNG SPACE'S, LOADING —DOCKS, FUEL <br /> V. WiTH APPLICATION, A $5.00 PROCESSING FEE <br /> \/i <br /> 1, hereby, ce�HK! and afFirrn tat alJ off -U-ie infonnation I have given in this appiioation is true an'd <br /> accurate to th best of my �,nowledge. I further certify and affirm the I have in no way <br /> aft empted toTpislead the Cityin t�is application by ornitting facits known to me. I have read <br /> and understard the regulations of the Scrap Metal Dealer/Junk Dealer/Racycling <br /> Oparationffvn insfer Station license found in the City of South Bend Municipal Code, Section <br /> Date <br />| � <br />' � <br />