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1 IWO. <br />9 N <br />jb��SE ri- <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center give, Roseville, MN 55113 <br />(651) 792 -7036 <br />Recycling Mauler License Application <br />------------------------------- <br />Fee Due; $125.00 Year License will be for January 1 to December 31. <br />r <br />Business Name {L� <br />Business Address A v <br />Business Phone & 1 — q 4j- — S, <br />5-- q <br />Contact Person _� �� � -,. • F `� Email Address � <br />Emergency Contact Information <br />If completed license should he mailed somewhere other than the business address, please attach separate sleet. <br />Recycling services will be provided to (check all that apply): <br />Residential 'Commercial ""Multifamily Industrial <br />Dumber of vehicles the applicant proposes to use in the collection of recyclables <br />Name and address of companies or materials recovery facility where recyclables wi 11 be delivered: <br />Newsprint * <br />�. <br />- r <br />y I <br />Off, -c e paper 1Boxbcar d * <br />Glass* <br />e, <br />Corrugated Cardboard* <br />*Required items for residential and multifamily haulers <br />cansIplas I is <br />lhe~(plea.se .specify) <br />1 have been provided with a copy of the City of Roseville Curbside Reeycliiig 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 />1 have attached a certificate of liability insurance, a certificate indicating Worker Compensation coverage, and the fee of $125.00, <br />f <br />Date Applicant's Signature Title <br />