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ne-cycling Hauler LicenSp A pplication <br />Fee Due: S 125-00 'Yea, X9 <br />Business Nlame L2 S <br />.WNW <br />Business Address 5 ho (0 1 <br />Business Phone <br />(License will be for January I to December 3 1.) <br />n I , SER I C <br />-Z <br />Contact Person 11 1'.. I V V Lj--J I NL-41*Mil Address <br />0% g <br />Emergency Contact, Information MW <br />If <br />completed license shou�ld be mailed somewhere other than the business address, please attach separate shcel. <br />Recycling services will be provided to (check all that apply), <br />Residential Commercial --)( Multifamily Industrial <br />Number of viehicles the applicant proposes to use in the collection, of riecyclables <br />Narne and address of complanies or materials recovery facility whierc recyclables,M]l be delivered: <br />V I <br />4 A <br />M-AP <br />*Requirecl items for resi�dlen,iial and mul(ifarnily haulers <br />1have been provided %vith a copy of'the City of Roseville Curbside Recycling Ordinance 2-n d understand that violation of any of the <br />�Pensionorrevocationiofthe i <br />provisions included in the ordinance may result jW<U h c e n. XT <br />,I hav,e, attached' a certificate of liability inisuranc <br />ate <br />IMMMMOMMM Owaff, <br />pplicant's Signature <br />nsation coverage, and the fee of $125.00. <br />0 <br />Title <br />