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��� � � <br />� <br />Finance Department, License Division <br />2660 Civic Center Drrve, Roseviile, MN 55113 <br />(651) 792-703b <br />Recycling Hauler License Application <br />F'ee Due: 5125.00 Year �� � 3 <br />Business Name ,�liti � o�' � <br />Business Address z �i� � <br />Business Phone <br />(License wil� be for Januaty 1 to December 31.} <br />�"!k l. or�• ��B/�i ', G � <br />�� <br />��y SF N� _ � <br />Contact �erson �mail Address <br />Emergency Contact Information _ <br />ekc, �cv�1�N4 ) <br />�—�� - <br />��4rol:s , ,�r,� SSy � 3 <br />�,�._ . . . . _. _ <br />�--- - � <br />If co�pleted iicense sbould be mai�ed somewhere other than the business address, pEease attac6 separate sheet. <br />Recycling services will be provided to (check all that apply): <br />�Residential �Commercial �Multifamily ❑Industrial <br />Numbcr of vchicles the applicant proposes to use in the collection of recyclables <br />Name and address ofcompanies or materials recovery facility where recyclables will be delivered: <br />Newsprint* Glass'� Cans/Plastic * <br />ivrtk�, Q��yc4i�,�_ ____ <br />Z kL SC �0,✓apr,���t1 � ��[i(/d/\ � �� e ._ _ <br />��QiS. NI�I SS�jJ� <br />�ce paper/Baxhoard* Corrugated Cardboard* <br />Other(please spec�) <br />��'_ n'-`� <br />� � <br />C�o�_� `I+JP�► S � Wc.f' s�'� <br />Te}ru Q�+�r,�[ <br />*Required items for residential and multifamily haulers <br />I have been provided with a copy of the City of Roseville Curbside Recycling Ordinance and understand that veo�ation oi' any of the <br />provisions included in the ordinance may result in suspension or revocation of the license. <br />i have attached a certificate of liability insurance, a ' cate ind� ting Wor �mpensation coverage, and the fee of $125.00. <br />r� 3 IZ ' �i��tc�er d� ��s�n,,,,�r �e���d�� <br />Date App �cant's Signature Title <br />