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bks ------- - Try T <br />4Mgm <br />V, EN <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, SIN 55113 <br />(5 1 ) 792 -7036 <br />Recycling Hauler License Application <br />Fee due: .00 Year 61 (License will be for January I to December 3I ) <br />business Name Wa-oaagilyl-,e r h r ?. ! .. jbi-C. <br />Business Address i6650 � 5 �h <br />Business Phone - °- <br />J. <br />Contact Person _ 5)1,e j _Q k kjQ_j,1 Email Address <br />Emergency{ Contact Information WX jj 4e-- <br />If completed license should be mailed somewhere other than the business address, please attach separate sheet. <br />Recycling services will be provided to (check all that apply): <br />X y <br />Residential— X, commercial `Multifamily Industrial <br />Number of vehicles the applicant proposes to use in the collection of recyclables � �� �� rA�� '� Y� c.� <br />Name and address of companies or materials recovery facility where recyclables will be delivered: <br />At 47 Le r I i} y <br />,�f a - -T- <br />1 # <br />-d-Li ms /I -j <br />.�. ce paperlBoxboard C or rugate d Cardb oa -rd * Other(pl -ease spe c ift <br />`Required items for residential and multifamily haulers <br />I have been provided wilh a copy of the City of Roseville Curbside Recycling Ordinance and understand that violation Of'any of the <br />provisions inciudcd in the ordinance may result in suspension or revocation of the license. <br />I have attached a certificaxc of liability insurance, a certificate indicating Worker Compensation coverage, and the fee of $125.00. <br />• f Ar\ <br />late Applicant's Signature Title <br />