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11jP, TM <br />L <br />Fee Due.: $125.00 Year AO I ) - (License w, i 11, be for Januar I to December 3 L) <br />19, ess Address <br />If completed license should be mailed somewhere other than the business address, please attach separate sheet. <br />Recy,ching ser ices will be provided to (check all that apply,): <br />Residential Commercial ol� Multifamily Industrial <br />Number of vehicles the applicant proposes to use in, the collection, of recyclables <br />Name, and address olf'com,panies or materials recovery facility where recyclables, will be delivered: <br />*Requiried items for residential and multifamily haulers <br />I have been provided, with a copy of the City of Rose bside Ilec 'I inance and un,der�st,and that violation of any of the <br />provisions included in the ordinance may result in sues or r�eVoca Ali <br />license <br />I have attached a certificate of liability insur ce,-,,, <br />.... . ..... <br />Date <br />FIF I III I 11� 1 11 11 111 1� illi��illi�ll <br />q <br />