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��� �.-,.�,-�r �� <br />,�a� � I � <br />Finance Department, License Division <br />2660 Civic Centcr Drive, Roseville, MN 55113 <br />{651) 792-7035 <br />Recycling Hauler License Application <br />Fee Due: $125.1?0 Year �� ��7 (License will be for January 1 to December 31.) <br />l <br />Business Name �C�' � 3 c� l� <br />r <br />1` � <br />Business Address , �'C � 1�"I , , � �� �� C t' � I, ` ��? ��7�� � <br />Business Phone lG 7 � `18� "� �y� <br />Contact Person <br />Email Address _ <br />a- <br />d ! <br />Emergency Contact Information <br />If completed license shoald be mailed somcw6ere other than the business address, please attach separate shee� <br />Recycling services will be provided to (check all that apply): <br />❑Residential �Commerciai [�Multifamiiy �I�dustrial <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 recyclabies will be delivered: <br />� Newsprint* Glass* <br />�,c.�t��� �t�;r-"�� � � � <br />l�(;(� °�c`_ ��L�`r�i�� � <br />���� � j'j') n.J °`��-1 / � <br />Offtce paper/Boxboard* Corrugated Cardboard* <br />� � fr <br />*Required items for residential and maltifamily haulers <br />I have becn provided with a coQy of the City of Roseville Curbside Recy <br />provisions included in the ordinance may resu�t in suspension or revo ic <br />I have attached a certificate of liability <br />i -� <br />Date <br />Signahue <br />Cans/Plastic * <br />�r <br />Other(please specify) <br />1� <br />ig Ordinance and understand that violation of any of the <br />of the license. <br />Worker Compensation coverage, and tlie fee of $] 25.00. <br />� Title <br />