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Scrap Metal Dealer /Junk Dealer /Recycling Operation License Application <br />Page 2 <br />K. Are premises: . Leased by applicant �_ owned by applicant? <br />If leased: Name of owner <br />Business address <br />111, PERSONAL DATA <br />A. Applicant's Legal Name <br />S. Residential Address - !15!2 �J'J • �Plt.('4R7 _ m city t.�.1ar-� State _ ZIP _41 <br />C. Residential Telephone Number <br />1=. Hate 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 />VI. AFFIRMATION <br />f, 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 />Ankal-�� /A 2,11 f6 <br />mature Z 15ate <br />