Laserfiche WebLink
Scrip i1/letal Dealer/Junk Dealer/Recycling Operation License Application <br />Page 2 <br />K.` Are premises: X Leased by applicant owned by applicant? <br />If leased: Name of owner <br />BARRY BURTON <br />Business address <br />HONON DRIVE, SOUTH BEND, INDIANA <br />III. PERSONAL DATA <br />A. Applicant's Legal Name <br />B. Residential Address _ <br />City <br />WASTE MANAGEMENT OF INDIANA LLC <br />20645 W. IRELAND ROAD <br />State IN <br />SOUTH BEND <br />C. Residential Telephone Number <br />D. SSN <br />E. Date of Birth <br />Zip 46614 <br />IV. INCLUDE, WITH APPLICATION, A SITE PLAN OF THE FACILITY SHOWING <br />PROPERTY LINES, BUILDINGS, PARKING SPACES, LOADING DOCKS, FUEL <br />STORAGE, AND LAI`~DSCAPING. <br />V. INCLUDE, WITH APPLICATIORI,~A $5.00 PROCESSING FEE <br />VI. AFFIRiViATION <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 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 />~- ~ ~z"`~`~~~ <br />Signature Date <br />