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Scrap Metal Dealer /Junk Dealer /ReWding Operation License Application <br />Page Z <br />K. Are premises: Leased by applcant ` owned by applicant'? <br />If leased: Name of owner <br />Business address <br />Ill. PERSONAL DATA <br />A. Applicants Legal Name ____.D&u r <br />13. Residentiaal Address. _ —06*11 <br />city y Gi art. state_ Zap -All t t <br />C. Residential Telephone Number <br />D. SSN " Z - 7 , _ E Dcde 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. <br />V1. <br />INCLUDE, WITH APPLICATION, A $5.00 PROCESSING FEE <br />AFFIRMATION <br />1, hereby, certify and affrnn 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. l have read <br />and understand the regulations of the Scrap Metal Dealer /Junk Deaier/Recycling <br />Operation/Transfer Station license found in the City of South Bend Municipal Code, Section <br />4-51. <br />3 0i 20t <br />