Laserfiche WebLink
Scrap Metal Dealer /Junk Deafer /Recycling Operation License Application <br />Page 2 <br />K. Are premises: Leased by applicant owned by applicant? <br />if leased: Name of owner <br />Businsss.address <br />111. PERSONAL DATA j <br />A. . Applicants Legal Name /�lri G /� -L �° je te r s. <br />B. Residential Address <br />City _<C9 v �-w State � 21p <br />C. Residential Telephone Number // t�Co -� S - ' C� <br />D. SSN �' C c ~C �. E. Date of Birth O 40V <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. -,t? Al Z fi (1p, -- <br />V. INCLUDE, WITH APPLICATION, A $5.00 PROCESSING FEE <br />VI. AFFIRMATION <br />I, 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 />451. <br />Signature Aale <br />