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For all municipal business license questions,contact: City of South Bend•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 <br /> A.Applicant's Legal Na LOU DOMINION <br /> B. Residential <br /> City: <br /> C. Residential Telepho • <br /> D.Cellphone Number: <br /> E. Social Security • F.Gend <br /> G.Date of Birth: H. Race: <br /> I.Position with Business MEMBER <br /> IV. INCLUDE, WITH APPLICATION,A SITE PLAN OF THE FACILITY SHOWING PROPERTY LINES,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 foun the City of South Bend Municipal Code,Section 4-51. <br /> 1-21-2026 <br /> Signature Date <br /> 2 <br />