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IUP Application <br /> Page Two <br /> Estimated Average Daily Truck Trips - <br /> Company Owned: C <br /> Non- company Owned: <br /> Estimated Peak Daily Truck Trips - <br /> Company Owned: <br /> Non - company Owned: <br /> Haul Routes 62/ sr )9 ✓t ro Ai 7-, Sr <br /> Supporting Documentation <br /> The City of Centerville requires submittal of supporting documentation. This application <br /> will be considered incomplete for processing if received without all required information. <br /> Fees and Reimbursement <br /> Interim Use Permit requires prepayment applications and processing fees,as <br /> well as reimbursement of all additional out of pocket expenses incurred by the City in <br /> processing the application. The fee shall be set Council resolution. <br /> Permit Term - <br /> The Maximum duration of the Mix permit shall be specified in the Interim Use Permit <br /> and Shall remain in effect, subject to annual renewal permits and compliance with the <br /> Interim Use Permit. <br /> AGREEMENT: <br /> I certify, to the best of my lmowledge, the application documentation submitted is correct. <br /> I am authorized to execute this document and I agree to reimburse the City; for all out of <br /> pocket expenses incurred in the review and processing of the application <br /> Signature: C <br /> Name: �� ' S kola <br /> Title: o Et( _C i'M-• tS <br /> Date: <br />