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6; <br /> f <br /> I % I <br /> City of Roseville <br /> Finance Department,License Division <br /> 2660 Civic Center Drive,Roseville,AIN 55113 <br /> (651) 792-7036 <br /> Recycling Hauler <br /> Fee Due: S 125.00 Year l (Li cense w!11 be for January 1 to December 31.E <br /> t <br /> Business Name o.� �' ' 1r <br /> Business Address 4 P�4 <br /> Business phone . --LA s, g -S <br /> Contact person Email Address <br /> IL <br /> Emergency Contact Information <br /> If completed license should he in ailed somewhere otber than the business address,please attach separate sheet, <br /> Recycling services will be provided to(check all that apply): <br /> Residential u/bo mmerciatMultifamily___�.Andustrial <br /> Number of vehicles the applicant proposes to use in the collection ofrecyclahles --- ..--- -- ._. <br /> Name and address of companies or materials recovery facility where recyclahles will he delivered: <br /> Newsprint* Glass* CanslPlaslic <br /> ir <br /> Office paperIBoxboard* Corrugated Cardboard* Other(please specify) <br /> *required items for residential and multifamily haulers <br /> I have been provided with a copy of the City of Roseville Curbside Recycling Ordinance and understand that violation of any of the <br /> provisions included in the ordinance may result in suspension or revocation of the license. <br /> I have attached a certificate of liability insurance,a certificate indicating Worker Compensation coverage,and the fee of$125.00. <br /> Date Applicant's Signature Title . . . <br />