Laserfiche WebLink
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 <br /> Business address <br /> III. PERSONAL DATA <br /> A. Applicants Legal Name 7.mc- Lr 1 z f r °-k' S <br /> B. Residential Address 27-?e, <br /> c�/�C <br /> City t �._t -_,--+-'1 State .TJl� Zip 'e'6 `-S �a <br /> C. Residential Telephone Number 5 "f — _� cl�L' V O <br /> ,�,/ E. Date of Birth , v-' �' <br /> D. SSN �: <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 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 />