Laserfiche WebLink
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 ~~ Y`n'n~ ~jCZV~'C~ ~Gr`pOY'a~\\~ U~ <br />B. Residential Address '-7 5 `~ 5 ~ , J e.~~ erSO r~ ~~ y 4 ' <br />City ~--0 ~' V~ awl Y~~.. State 1 ~ Zip `4 ~ ~ ~ `~ <br />C. Residential Telephone Number ~~ o " t-+ ~ 9 - `~ 3 `~ `l <br />p, may- 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 />1, 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/Transfer Station license found in the City of South Bend Municipal Code, Section <br />4-51. <br />~-fl-~~ <br />Signature Date <br />SCE ~IZES1 pEts- <br />