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For all municipal business license questions,contact: City of South Send•Ordinance Violation Bureau <br /> 227 West Jefferson Blvd•Suite 455-South Bend,Indiana 46601•574,235.6052•F 574.235.9173 <br /> LICENSE APPLICATION FOR — SCRAP METAL DEALERS/JUNK DEALERS/RECYCLING <br /> OPERATIONS <br /> CITY OF SOUTH BEND, INDIANA <br /> MUNICIPAL CODE SECTION —4-51 <br /> III. PERSONAL DATA 1' <br /> A. Applicant's Legal Name: ��f11 t�� t\ ,vy ~ <br /> B. Residential Address: <br /> City: State: Zip: <br /> C. Residential Telephone N <br /> D. Cellphone Number: <br /> `E. . F. Gender: - <br /> G. Date of Birth: H. Race: <br /> I. Position with Business <br /> IV. INCLUDE, WITH APPLICATION, A SITE PLAN OF THE FACII I I SHOWING PROPERTY LINES, BUILDINGS <br /> i <br /> PARKING SPACES, LOADING DOCKS, FUEL STORAGE,AND LANDSCAPING. <br /> V. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION I <br /> VI. AFFIRMATION <br /> C <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 and <br /> understand the regulations of the Scrap Metal Dealer/junk Dealer/Recycling Operation/Transfer <br /> Station license found in the City of South Bend Municipal Code,Section 4-51. <br /> � ,, � t a �' <br /> Signature Date <br /> 2 <br />