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Scrap Metal Deafer/Junk Dealer/Recydng Operat on Ucense Application <br />Page 2 <br />\Z <br />K. Are premises: �n-\ Leased by applicant <br />y <br />If leased: Name of owner 0�t � <br />Business address :q-6- ��11 ( I <br />111. PERSONAL DA <br />A. Applicant's <br />B. Residential <br />City <br />C <br />D. <br />Residential <br />SSN <br />- - I: --n <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 />V1. 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 />Date <br />ci <br />