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City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651. 792-7036 <br />Xecycling Hauler Licenise Application' <br />jw11% <br />Fee Dlue: S 1251,001 Year, Do —I— (License will be for January I to December 3 1.) <br />? <br />Business Address > <br />Business Phone <br />Contact Person A. Fmail Address <br />Emergency Contact Information <br />FA <br />If complleted Ficense should be mailed somewhere other than the business adddlress, please attach separate sheet. <br />Recycling services cies will be Ipirovid�ed to (check all that apply), <br />VResidential X ComrnercialX Multifamily Industrial <br />Number of vehicles the applicant proposes to use in the collection of recyclables <br />Name and address of companies or materials recovery facility where recyclables will be delivere& <br />2,V^15 E: <br />MOM jy\ <br />Offic e <br />Bra d„ <br />G�a "s t " onsIPI ti <br />............... -.ol"Solrlm� <br />. .... . S&W <br />Carrugat d Cardboard* <br />i,; 1A 4x-A)C <br />*Requiried items �for residential and multifamily haulers <br />01her(please specs <br />,y) <br />I have been providled kvith 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 inprance, a certificat�e inad;cating Worker Compensati(yn coverage, and the fee of S12-54M, <br />Date Applicant's Signature Title <br />