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���� <br />.J�-- � � v �� <br />Finance Department, License Divisiun <br />266U Civic Center Drive, Rosevilie, MN 55113 <br />(651) 792-7035 <br />Recycling Hauler License Application <br />Fee Due: $125.00 Year ���� {License will be for January 1 to December 31.) <br />Business Name _�[�„� �/�`� ��"��� , ��C`. - <br />Business Address �. �J �G�Li � j� `S., <br />Business Phone <br />Contact Person <br />Email Address <br />� <br />Em�g�ncy Contact Information , _ , ,� _ <br />_ ,_._„—__�-�. - --- <br />If completed license s6ould be mailed somewhere other thaa the business address, please aftach separate shee� <br />Recyciing services will be provided to (check all that apply): <br />�Residential �Commercial �Muitifamily �Tndustrial <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 deiivered: <br />Newsprint `' <br />�R�� ���� <br />O�ce paper/Boxboard'k <br />�'��n��-- p��� _ <br />lass* Carrs/Plastic * <br />� ��� ��ti�7���� <br />Corrugated Cardboard* Other(pCecrse spec�) <br />_ �tDI��Z �A�E�"-- <br />*Required items for residential and multifamily haulers <br />� <br />I have been provided with a copy ofthe City of Roseville Curbside Recycling Ordinance and understand that violation of any of the <br />provisions inciuded in the ordinance may result in suspension or revocation of the license. <br />T have attached a certificate of liability insuran�e,.�certificate indicating Worker Compensation coverage, and the fee of $125.00. <br />. <br />� __ _,„ <br />Date Applicant's Signature Title <br />