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rVIC, T T T"� <br />W kwo S <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MCI 55113 <br />(651) 792 -7036 <br />Recycling Hauler I.,icense Application <br />- -- --- -- --- --- ------ ---------- ----- <br />-------------------- <br />Fee Due: $1 25.00 Year � � (License will be for January l to December 3 I . <br />Business Name / FC69 <br />Business Address s <br />Business Phone 5-2 - .�a- A L/ -� <br />Contact person I' -c' -Email <br />Address <br />Emergency Contact Information <br />16t rLc,k. t-ov" Ss- /i 7 <br />If completed license should he mailed somewhere other than the business address, please -attach separate sheet. <br />Recycling services will be provided to (check all that apply). <br />�R-esiderltia -1 _ cornmercial�Multifamily industrial <br />?Umber of vehicles the applicant proposes to use in the collection of recyelables <br />Nance and address of companies or materials recovery fact €ity where recyelables gill he delivered: <br />NeivsPrrnt * Glass* CanslPfasiio ` <br />WA y- <br />Tv,� <br />3 <br />Office paperlBoxhocird * Corrugated Cardboard* Olher (please specify) <br />1&-,r <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 revocations of the license. <br />I have attached a certificate of liability ins ee, a certificate ind1 acing Worker Compensation covera e, and the fee of S 1 25,00_ <br />Date ^ Applicant's Signature Title <br />