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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 ~~ mn~ Sov°~'C~ ~,~,pr(~oY'a~-~ Uh <br />B. Residential Address '~7 S ~ 5 ~ ~ J e_~~ e.rSO r~ ~~ y ~ ' <br />City ~O ~' W ail Y~~. State 1 ~ Zip `~ ~ g ~ <br />C. Residential Telephone Number c~(r d - ~--~ ~ 9 - `f'J y C/ <br />D. Ord- _ 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 ±he 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 />~.-il-~~ <br />Signature Date <br />~~C~~ac~~ ~. ~o~t~s~TTE <br />~ CE ~ fZES t pEtSi <br />