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I i <br />Fee Due: S 125.,001 Year A,@103 (License Nvill be for January I to December 3 1.) <br />�L) ? <br />Business Name ec" <br />B,usiniess Address Ro. <br />'? -7 <br />Business Phony 94(o, <br />Contact Person, a% Email Address <br />E,merge,nicy Contact Information <br />Ificomplieted license should be mailed somewhere other than thie business address, please attach separate sheet. <br />Recycling services will be provided to (check all that apply): <br />-Residential Commercial Multifamily Industrial <br />Number of vehicles the applicant proposes to use in the collection of recyclables <br />Name and address of compan�ie,s or materials recovery facility where recy,clables will be delivered-, <br />Newsprint* <br />N <br />Office paperlBioxboard * <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 io liability insurance, a cerlifi ate indicating Worker Compensation coverage, and the fee of $125.00, <br />insurance, a <br />a Fl, ate I J c adn g ", o <br />Cer' I" <br />os <br />P ig nature <br />Diate Cdro##4A icant's Signaturie Title <br />V.-0100- - <br />