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Scrap Metal Dealer /Junk Dealer /Recycling Operation License Application <br />Page 2 <br />K. Are premises: Z. - Leased by applicant owned by applicant? <br />If leased: Name of owner ite-r� =n C. . <br />Business address p 2- L d We-&E Baid <br />III, PERSONAL DATA `` <br />A. Applicant's legal Name V +Ct L �c� <br />B. Residential Address tt(a44� C.tAcLr- ' oc"k <br />City NQJ VV-&C-k- State r Zip _4(a5 73 <br />C. Residential Telephone Number 5f1 '- 63.3- I <br />o Fi x <br />D. SSN E. Date of Birth J 1 -6:1 <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. <br />INCLUDE, WITH APPLICATION, A $5.00 PROCESSING FEE <br />VI. AFFIRMATION <br />1, 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 />-W� 0 -6, 5� -10 <br />Signature Date <br />