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Scrap Metal Dealer/Junk Dealer/Recycling Operation License Application <br /> Page 2 <br /> K. Are premises: Leased by applicant V owned by applicant? <br /> If leased: Name of owner S VIA-4c %.* tar-C 0'0 S%‘P%Cej; <br /> Business address Q o st) <br /> Ill. PERSONAL DATA <br /> A. Applicant's Legal Name , S‘1 pce <br /> B. Residential Address <br /> City ('� - State Zip 4L3 <br /> C. Residential Telephone Number <br /> D. SSN - L04-' <br /> E. Date of Birth .3 i L0 1 a 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. 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-c1. <br /> Signature Date <br />