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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 ~ 1 1'71 <br />Business address 1400 S ~~' ~t N I ~2-S , i~. i ~~ ~ ~~ <br />III. PERSONAL DATA 'n <br />A.. Applicant's Legal Name ~ n t~ ~ K-~ n O re WS <br />B. Residential Address 5 ~.~3 L ~~ V P~~~1 ~~C~ rrr1~4- 1 <br />City ~s rr.~ State ~ Zip ~~_~ ~~_ <br />C. Residential Telephone Number ~~ ~-- ~'~ ~ - ~ ~' ~ ~i <br />D. SSN _ _ E. Date of Birth ~~~ ~ S ~- <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 APPLICATIO ~A $5.00 P CESSING 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 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 />~-51. <br />_ ~ ~ ~~~ <br />Signature to <br /> <br />