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For all municipal business license questions,contact: City of South Bend•Ordinance Violation Bureau <br /> 227 West Jefferson Blvd•Suite 455*South Bend,Indiana 46601•574.235.6052•F:574.235.9173 <br /> LICENSE APPLICATION FOR —SCRAP METAL DEALERS/JUNK DEALERS/RECYCLING <br /> OPERATIONS <br /> CITY OF SOUTH BEND, INDIANA <br /> MUNICIPAL CODE SECTION -4-51 <br /> III. PERSONAL DATA <br /> A.Applicant's Legal Name: Ct pLL� 1 <br /> B.Residential Address:eeo() W . L ' <br /> City: 3°M j)n State:.J j Zip: "C (O Io t - <br /> C. Residential Telephone Number: 5-744- .qq -0SScr <br /> D.Cellphone Number: q' q j 4(0 <br /> E. <br /> G. <br /> I. Position with Business Iinn <br /> IV. INCLUDE,WITH APPLICATION,A SITE PLAN OF THE FACILITY SHOWING PROPERTY LINES,BUILDINGS, <br /> PARKING SPACES, LOADING DOCKS,FUEL STORAGE,AND LANDSCAPING. <br /> V.INCLUDE$5.00 PROCESSING FEE WITH APPLICATION <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 and <br /> understand the regulations of the Scrap Metal Dealer/Junk Dealer/Recycling Operation/Transfer <br /> Station license found in the City of South Bend Municipal Code,Section 4-51. <br /> jet, i&ait/tife4. <br /> — p/ RV <br /> Signature Date <br /> 2 <br />