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Scrap Metal Dealer /Junk Dealer /Recycling Operation /Transfer Station License Application <br />Page 2 <br />III. PERSONAL DATA <br />A. Applicant's Legal Name INTASTE .MANAGEMENT OF INDIANA LLC <br />B. Residential Address 20645 W IRELAND ROAD <br />City SOUT?? BEND State TWT Zip 46614 <br />C. Residential Telephone Number <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 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 /Transfer Station license found in the City of South Bend Municipal Code, Section <br />4 -51. <br />&8Lng w �,5 �6 ? , - <br />UT v <br />Sign kA � ate <br />