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�I�,�� I� <br />i-� �' v ��..� � <br />Finance Department, License Division <br />2660 Civic Center Drive, Rosevi�le, MN 55113 <br />{b51) 742-7036 <br />Recycling Hauler License Applica�ion <br />Fee Due: S12S.00 Year �� (License will be for ]anuary I to December 3I,) <br />Business Name <br />IGMTMIRG �15R05AL <br />Business Address <br />EA&AN MN 5511i <br />Business Phone <br />Contact Person Email Address <br />Eme�gency Contact Information <br />0 <br />If completed iicense should be mailed somewhere other Wao the business address, please attach separate sheet. <br />Recycling services will be provided to (check all that apply): <br />❑Residential ❑Commercial �Multifamily ❑Industrial <br />Number of vehicles the applicant proposes to use in the eolleetion of recyclables <br />,r <br />Name and address of companies or materials recovery facility where recyclables rvill be delivered: <br />Newsprint* <br />�ce paper/Boxboard* <br />Glass'" <br />Corrugated Cardboard* <br />*Required items for residential and multifamily haulers <br />Carrs�/Plasttc * <br />Other(plerrse spec�) <br />� �k � cl:�.� - �� <br />i have been provided with a copy ofthe City ofRosevilie Curbside Recycling Ordinance and understand that violation of any ofthe <br />provisions included in the ordinanee may result in suspension or revocation ofthe license. <br />I have attmched a certificate of liability insurance, a certificate indicating Worker Compensation coverage, and tlie fee of $125.00. <br />I � �� ~ [ �_ � i'��'�" _ ..�/� 9 .ii <br />Date Applicant's Signature Title <br />