Laserfiche WebLink
2 <br />For all municipal business license questions, contact: City of South Bend • Department of Community Investment <br />227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 <br /> <br /> <br />LICENSE APPLICATION – OPEN-AIR FOR DONATION BOXES AND CONTAINERS <br />MUNICIPAL CODE SECTION - 4-38 <br /> <br />III. APPLICANT’S PERSONAL DATA <br />A. Applicant’s Legal Name: <br />B. Residential Address: <br />City: State: Zip: <br />C. Residential Telephone Number: <br />D. Cellphone Number: <br />E. Position with organization: <br /> <br />IV. RESPONSIBLE INDIVIDUAL (for monitoring, emptying, maintaining, and responding to calls to clean <br />the area around the box or container). <br />A. Legal Name: <br />B. Residential Address: <br />City: State: Zip: County: <br />C. Residential Telephone Number: <br />D. Cellphone Number: <br />E. Position or Relationship to Applicant or Charitable Organization: <br /> <br /> <br /> <br /> <br />V. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION <br /> <br />VI. INCLUDE SITE PLAN DRAWING OR DIAGRAM SHOWING PROPOSED LOCATION AND DRAWING OR <br />PHOTO OF DONATION BOX OR CONTAINER, INCLUDE THE DISTANCE THE BOX WILL BE SETBACK FROM <br />THE PROPERTY LINE. INCLUDE NORTH ARROW. <br /> <br />VII. INCLUDE WRITTEN STATEMENT OF PERMISSION FROM PRIVATE PROPERTY OWNER/LESSEE. <br /> <br />VIII. AFFIRMATION <br /> <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 that I have in no way attempted to <br />mislead the City in this application by omitting facts known to me. I have read and understand <br />the regulations of the Open-Air Business license found in the City of South Bend Municipal <br />Code, Section 4-38. <br /> <br /> <br /> <br /> <br />Signature Date