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ror a l municipal business license Questions,contact: City of South Bend•Croinance Violation Bureau <br /> 227 West Jefferson Blvd•Suite 455*South Bend,ind'ana 46601•574.235 6D52•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 <br /> A.Applicant's Legal Name: Jason W Grube <br /> B. Residential Address <br /> City State: IN Zip: <br /> C. Residential Telephone Number: 765-776-2436 <br /> D.Cellphone Number: 765-776-2436 <br /> E <br /> I. Position with Business Owner <br /> IV. INCLUDE,WITH APPLICATION,A SITE PLAN OF THE FACILITY SHOWING PROPERTY UNES,BUILDINGS, <br /> PARKING SPACES,LOADING DOCKS,FUEL STORAGE,AND LANDSCAPING. <br /> V. INCLUDE$5.00 PROCESSING FEE WITH APPLICATION <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 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 /> le.9 <br /> 12-5-24 <br /> .46' Signature Date <br /> 2 <br />