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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 1'11 <br />Business address l ~ 00 ~ ~~, ~ fi N i ~2 ~ 1~. i ~~ ~ ~~ <br />III. PERSONAL DATA 'n <br />A. Applicant's Legal Name ~2. h -~, C K-~ h O re WS <br />B. Residential Address <br />City ~r,4 ,~ ~ State ~ ,~ Zip ~~~ ~~ <br />C. Residential Telephone Number ~~] ~-- ~'~ 3 ~ ~ y' ~~=i <br />D. SSN E. Date of Birth ~1 ~~~ ~ ~ ~-- <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 no way <br />attempted to mislead the City in this application by omitting facts known to me. 1 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 />S~~ <br />Signature to <br />!'` . _ - <br />