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9jPkjr"M <br />L <br />- d [A <br />Fee Due; $125.00 Ycar (License will be for January I to December 3 1.) <br />Business Name VL+, tj <br />Business Address <br />69e 11 <br />Business Phone—q-5---Q- <br />-RPM% -OWN <br />Contact Person W t I.Email Address <br />Emergency Contact Information <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 />Residential V-iCommercial Multifamily­__Vn�lridustrial <br />Number of vehicles the applicant proposes to use in the collection of recyclables <br />Name and address of companies or materials recovery facility where recyclables will be delivered-, <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 />r�irovisions included in the ordinance may result in suspension or revocation of the license. <br />I have attached a certificate of liabiliV insurance, a certificate indicating Worker Compensation coverage, and the fee of $125.00. <br />YO, ta sej <br />Date Applicant's Signature Title <br />