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IM111 mto <br />Flee Due $12,x.00 Year --.4, 00 3 101 (License will be for January I to December 3 1.) <br />Businiess Name <br />i- <br />Business Address <br />1Y V <br />Businiess Phone 4 09- 40; 2- <br />Contact Person ape & <br />Lmail Address <br />Emergency Contact Information <br />If completed license should be mailed somewhere other than the business address, please advise. <br />Solid waste collection will be Provided to (check all that apply): <br />k"'Residential (single family, duplex, triplex, fourplex) <br />P' Multiple Residential (apartment, condominium, manufactured home park, and townhouse) <br />I/ Commercial/Industrial <br />Number of vehicles the applicant proposes to use in the collection of siolid waste <br />Name and address of disposal or recycling facilities to which waste will be hauled: <br />Garbia,ge Yard Waste <br />10 XW1 C- 4(4 <br />Briish <br />11 <br />A ddition,a] Ifenis su ch as applian ces <br />(atfach a(ldlUonal sheet if necessaq) <br />