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Scrap Metal Deafer /Junk Denier /Recycling Operation License Application <br />Page 2 <br />K. Are premises: <br />Leased by applicant �� owned by applicant? <br />If !eased: Nag-ie of owner <br />Business address <br />III. PERSONAL DATA <br />A. Applicant's Legal Name <br />B. Residential Address <br />C <br />Is] <br />City <br />Residential Telephone dumber <br />SSA! <br />State ' mot-' Zip <br />B. Date of Birth <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 />V1. AFFIRMATION <br />1, 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. /T ransfer Station license found in the City of South Bend Municipal Code, Section <br />4 -51. <br />Signature <br />Date <br />