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C 0 <br />ty '&- <br />i of Roseville <br />Finance DIepartm,ent', License Division <br />1 1 <br />2660, Civic Center, Drive, Roseville, AIN 5'5'11,3 <br />(651) 79 1 2-7036 <br />%LXMwjaAL7"j.v IP 1r!,1PjA,vJ ... W ... WVIL IPV" I <br />Fee Due: $125.00 Year_;:41%N (License will be for January I to December 3 <br />'ATL - .0 P 101"I <br />CREM" <br />If completed license should, be mailed somewhere other than the business address, please, attach, separate sheet. <br />Recycling services will be provlid,ed to, (check all that apply): <br />XResidential Commercial - ' I <br />Multifarnily Industrial <br />Number of vehicles the applicant proposes, to use iti the collection of recyclables <br />1141111:11 1 <br />• 1 1 1 � <br />11111111 Is <br />III ITT* I <br />.LT IL F� <br />.000I Glays* CanslPlaytic <br />hII <br />A <br />orrugated Cardboard* 01her(please speclifi) <br />*Required, *Items for residential, and multifamily haulers <br />I have been provided w1ith a, copy of the Clity of Roseville Curbside Recycling Ordinance and understand that violation of any ofth-S <br />provisions included in the ordinance may, result in suspensi I on, or revocation, of the license,,. <br />0, 411111 v 0 1 <br />I ha-ve attached a ceftificate of liabill insu, 11 Worker Compensation coverage, and th ee o' 125.00. <br />ty <br />Date Applicant"s Sighature Title <br />