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Scrap Metal Dealer /Junk Dealer /Recycling Operation License Application <br />Page 2 <br />K. Are premises: Leased by applicant L -' owned by applicant? <br />If leased: Name of owner - <br />Business address 51 Q 7 C-C-&, .-, 1-t V -e— ZS' -Y <br />III, PERSONAL DATA <br />A. Applicant's Legal Name <br />B. Residential Address Z,. � r C> G 1%j <br />city 9 c? State Zip C <br />C. Residential Telephone Dumber 2. 7 <br />D. SSN 2 <.. "7 7--2- LL l Z, 2— E. Date of Birth l <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 I have given in this application is true and <br />accurate to the best of my knowledge. I further cedif�yy 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 />Signatu U Date <br />