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Scrap Metal Dealer /Junk Dealer /Recycling Operation License Application <br />Page 2 <br />K. Are premises: Leased by appiicant / \ owned by appiicant? <br />If [eased: Name of owner <br />Business address <br />III. PERSONAL DATA � <br />A. Applicant's Legal Name xr- �n nl --tri <br />B. Residential Address <br />Cl r <br />city u`�rl {�j ��1 State_ Zip <br />C. Residential Telephone Number `_`? �� L{ XfgC" 5 1-5C <br />D. n f 7 c n., +e Of 0;.+6 1 � � 7. Q 11( <i � 1. <br />� I <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 />VI. AFFIRMATION <br />I, hereby, certify and affirm that all of the information [ 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 /Transfer Station license found in the City of South Bend Municipal Code, Section <br />4 -51. <br />gnatur-Q% } / "` } bate <br />X n d h <br />