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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 <br /> Business address <br /> III. PERSONAL DATA �2 <br /> A. Applicant's Legal Name o e�✓c 4' - t r``� ' s"�% � S <br /> B. Residential Address e clic i-- a-- 's <br /> 1U <br /> City S c -)\i't„ ! �- --�'I State , Zip V(6 <br /> C. Residential Telephone Number s i — _7 f L 10 8 <br /> D. SSN � E. Date of Birth <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 /> i 7-- /7 <br /> Signature Date <br />