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Scrap Metal Dealer/Junk Dealer /Recycling Operation License Application <br />Page 2 <br />K. Are premises: ' Leased by appikaant , �_ 0*1W by appiicaW <br />Name of t vAw <br />Business address <br />Ill. PERSONAL DATA <br />A Appiicenrs L"W Noma .ThOM46 +- 3.16!4 ..� <br />B. RnIde tiel Address---J244 . b� M stun 5 <br />city _ &o.-1-/, &id/ state dip Y&e."3 <br />C. Reskieritiai Telephone Number 6-7!Z- algf- 7sl i <br />D. SSfii _ 3 C37 -� --L G E. Date of Birth <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 />Vt. 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 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 />4-5?. <br />J C, <br />t Date <br />