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Scrap Metal Dealer/Jurtlc Dealer/Recycling Operation License Application <br />Page 2 <br />K. Are premises: X <br />If leased: Name of owne <br />Leased by applicant owned by applicant? <br />~ BARRY BURTON <br />Business address HONAN DRIVE, SOUTH BEND, INDIANA <br />PERSONAL DATA <br />A. Applicant's Legal Name WASTE MANAGEMENT OF INDIANA LLC <br />B. Residential Address 20645 W. IRELAND ROAD <br />City SOUTH BEND <br />C. Residential Telephone Number <br />D. SSN <br />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 />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/Transf r Station license found iri the City of South Bend Municipal Code, Section <br />4-51. ~~ <br />Signature <br />State IN <br />Zip 46614 <br />~~ ~~`O`~ <br />Date <br />