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Scrap Metal Dealer /Junk Dealer /ReckdIng Operation License Application <br />Page 2 <br />K. Are premieee: Leased by applicant L-"" ovmed by applicant? <br />if leased: Name of owner - - -- -- a�� ty ---- L[ S"Z 07c c...a <br />Business address 3 J t Ce-Ar, i .a, ;.t V-e- 6 . <br />Ill. PERSONAL DATA <br />A. Appfiaarft Legal Name _ - - - -621�& �- /`-'7 //c .?o J <br />13. Residential Address 2 2,.1 �'?} �y'f3 /V rA 2 4 <br />City g z n State zip�'� t �I <br />C. Residential Telephone Number 2- -C—' 7 Z1�'-17 <br />D. SSN 3f cy "? 2.Z q l Z..:—, E. Date of e#th <br />IV. INCLUDE, WITH APPLICATION, A SITE PLAN OF THE FACILITY SNOWING <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 atrmn 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 />2-0 ! G <br />Date <br />