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Tj <br />r "inance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7036 <br />AN Is 7 V 0! <br />Ke%,,.yc1in" flauler Li se App ca, io:4 <br />i; icen <br />---------------------------------------- - <br />.... . ....... <br />............. <br />Fee Due: $ 1,25.,00 Year i(L,i'cense swill be for January. I to, December 3 1.) <br />Business Name U <br />Erniergency Contact Information <br />It completed license should be mailed somewhere other, than the business address, please attach separate sheet. <br />Recycling services will be provided to (check, all that apply): <br />Aesidential Cornmerciial Multifamily Industrial <br />Number of vehicles, the appil icant proposes to use in the collezdon of recyclables !I <br />Name and address ofoomplanies or materials, riec,ove�ry faclifity, where recyclabiles will be delivered: <br />int <br />Office PaperlBoxboard* <br />Glass * CanslPlastic * <br />U3 - JAft --I �,, cr, K6 M PF <br />1-3 <br />r w.ro�.... �gcyG� <br />IA <br />*Required items for residential and multifmily haulers <br />Other(Please specify) <br />I h,av,ie been provided', with a copy of the City of'Rolsevil�l,e Curbside Recycling Or'd�inance and understand that violation of any ofthe <br />It in suspensi oc,at,ioln of the license., <br />provisions included in the ordinance may resu ioln or rev <br />I have attached a certificate of liability insurance, a, certificate indicating Worker Compensation coverage, and the fee of $125.00. <br />Date Appilli,cant's Signature Title <br />