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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 />III. PERSONAL DATA <br />A. Applicant's Legal Name /~'vt..e~ ~~~`~'~ ~~ <br />B. Residential Address 2, Z ~ S ~ (~a r= ~ ~ © l~l ~'i2 ~ I <br />City ~U , ~ '~v'1 d. State C I~ ~G Zip ~ (v C~ ~ y <br />C. Residential7elephone Number ~ l' ~ ~ ~~•' ~ ~~ - <br />D. SSN E. Date of Birth q " ~ I ~ Z U <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 />`~r <br />I, hereby, certify and affirm that all of the information 4 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 noway <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 />4-51. <br />~~ ~^ ~ <br />Signature <br />Date <br />