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Name and address of each transfer station, disposaI facility and composting facility used for each offihe following: <br />(attach additional pages if needed) <br />Garbage <br />�lro �-A- <br />Yard WasteBrush <br />.'�' i y :ir <br />Construction/Demoiition Debris <br />��.������ <br />� ��� <br />� �1. r , ,w i <br />* t.�/ � : i � <br />Include a copy of the disclosure form used to inforrr► customers of the disposal facilities used by the applicant. <br />Residential Customer Rates <br />Please include all relevant ta7ces 3nd fees including surcharges. <br />These will be published and otherwise made available to residents. <br />Service <br />�-�J ,�Y�Gallon Service* <br />�j J ,.6� Gatlon Service�` <br />q 'r�` �Gallon Service'� <br />Wa1k-up Service* <br />Additional Garbage* <br />Yazd Waste* <br />*"I1►ese services are required to be offered in Roseville. <br />Cost <br />- - .,�er monih) <br />_ _ , �(per month} <br />— . , -.rer monlh) <br />_ _ _ „�er month) <br />I have been provided with a copy of the City of Roseville Solid Waste Collection Ordinance arid understand that violation <br />of the provisions included in the ordinance may result in suspension or revocation of the iicense. <br />I have attached a certificate of liability insarance, a certificate indicating Worker Compensation coverage, the fee of <br />$125.00, and a copy ofthe disposal facility disclosure form. <br />� ��� <br />Applicant's Sig�ature <br />�� <br />Title <br />� �' IS� ! d-- <br />Date <br />