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Scrap Metal Dealer /Junk Dealer /Recycling Operation License Application <br />Page 2 <br />K, Are premises: 'Leased by applicant ✓gowned by applicant? <br />If leased: Name of owner <br />Business address <br />III. PERSONAL DATA <br />A. Applicant's Legal Name � ' t r=Swe <br />B, Residential Address It-- nq <br />City � �i State ttlj Zip 7%S 0 <br />C. Residential telephone Number'] <br />D. SSNN S" 1"3 - 2ZZt� E. Date of Birth L" - 2 S AQ) A g-. <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 />1, hereby, certify and affirm that all of the information l have given in this. application is true and <br />accurate to the best of my knowledge. I further certify and affirm that l have in no way <br />attempted to mislead the City in this application by omitting facts known to me. 1 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 Send Municipal Code, Section <br />4 -51, <br />at a Date <br />