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Scrap Metal Dealer /Juhk Dealer /Recycling Operation License Application <br />Page 2 / <br />K. Are premises �—. <br />Leased by applicant `O�Red by applicant? <br />If {eased: Name of owner <br />Business address <br />Ill. PERSONAL DATA <br />A. Applicant's Legal Name <br />B. Residential Address <br />State �1U Zip <br />city � v' T 4 � , /,, — <br />C. Residential Telephone Number <br />D. SSNN�L.B• Date of Birth <br />v <br />IV. INCLUDE, WITH APPLICA T ION, A SITE PLAN OF THE FACILITY SHOWING <br />PROPERTY LINES, BUILDINGS, PARKING SPACES, LOADING DOCKS, FUEL <br />STORAGE, AND LANDSCAPING. <br />V. [ NCLUDE, WITH H 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 omitt <br />{erlJunit Dealer /Recyc{ ng have read <br />and understand the regulations of the Scrap M etal D a <br />Oceration /Transfer Station license found in the City of South Bend Municipal Code, Section <br />4 -51. <br />Date <br />signature . <br />