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2 <br />For all municipal business license questions, contact: City of South Bend • Department of Community Investment <br />215 S. Dr. Martin Luther King Jr. Blvd. • Suite 500 <br />South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 <br />LICENSE APPLICATION FOR – FERTILIZER MANUFACTURING FACILITIES <br />MUNICIPAL CODE SECTION – 4-23 <br />III. PERSONAL DATA <br />A.Applicant's Legal Name: <br />B.Residential Address: <br />City: State: Zip: <br />C.Residential Telephone Number: <br />D.Cellphone Number: <br />E.Position with Business: <br />IV. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION <br />V. INCLUDE WITH APPLICATION, A SITE PLAN OF THE FACILITY SHOWING PROPERTY LINES, BUILDINGS, <br />PARKING SPACES, LOADING DOCKS, AND LANDSCAPING <br />VI.INCLUDE WITH THE APPLICATION, EVIDENCE OF APPROVAL FROM ALL FEDERAL, STATE, AND LOCAL <br />AGENCIES HAVING JURSIDICTIN OVER CITING CONSTRUCTOIN AND OPERATION OF FACILITY, INCLUDING <br />COMPLIANCE WITH SECTION 21-04.02 OF THE MUNICIPAL CODE OF SOUTH BEND <br />VII.ANY ADDITIONAL INFORMATION REQUIRED BY THE BOARD OF PUBLIC WORKS AS TO OWNERSHIP <br />AND OPERATION OF THE FACILITY <br />VIII. AFFIRMATION <br />I hereby certify and affirm that all information I have given in this application is true and accurate to the <br />best of my knowledge. I further certify and affirm that I have in no way attempted to mislead the City in <br />this application by omitting facts known to me. I have read and understand the regulations of Fertilizer <br />Manufacturing Facilities as found in the City of South Bend Municipal code Section 4-23. <br />Signature Date