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Scrap Metal Dealer /Junk Dealer /Recycling Operation License Application <br />Page 2 <br />K. Are premises: Leased by applicant — owned by applicant? <br />!f leased: Name of owner@- <br />Business address RZOO S7 emu, AU L% <br />Ill. PERSONAL DATA <br />IV. <br />V. <br />Vl. <br />A. Applicant's Legal [dame <br />B. Residential Address <br />City R%Ira ze w State 'L Zip 6 <br />C. Residential Telephone Number <br />D. SSN 331 °- oz— 3 B. Date of mirth <br />INCLUDE, WITH APPLICATION, A SITE PLAN OF THE FACILITY SHOWING <br />PROPERTY LINES, BUILDINGS, PARKING SPACES, LOADING DOCKS, FUEL <br />STORAGE, AND LANDSCAPING. <br />INCLUDE, WITH APPLICATION, A $5.00 PROCESSING FEE <br />AFFIRMATION <br />1, hereby, certify and affirm that all of the information I Dave 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 />Signature <br />L Z--M �� <br />