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Name and address af each transfer station, disposal facility and composting facility used %r each of the following; <br />(attach additional pages if needed) <br />Garbage ConstructionlDemolition Debris <br />��if�A��6-��- I � N.tD��� . � �p N1 <br />N� ° � � �� �Mr�] tn� 1�.- �L�D.��....__ ..— <br />Yard WasteBrush <br />�3 D C�����1 f Yl�. 5 <br />Organics <br />Include a copy of the disclosure form used to inform customars of the disposal iacilities used by the applicant. <br />Residential Customer Rates <br />Please include all relevant taxes and fees including surcharges. <br />These will be published and otherwise made available to residents. <br />Service <br />7�j �3`1 Gallon Service* <br />(p � � Gallon Service* <br />�j � �5 Gallon Service�' <br />Walk-up Service* <br />Additional Garbage* <br />Yard Waste* <br />*These services are required ta be offered in Roseville. <br />Cost <br />I`j'_ {per month) <br />� 5 � (per month) <br />� � • (per i�andi) <br />L.I� � Y � �J�}� (per month) <br />�, � <br />�� '! <br />I have been provided with a copy ofthe City ofRoseviIle Solid Waste Collection Ordinance and tulderstand that violation <br />of the provisions included in the ordinance may result in suspension or revocation of the license. <br />I have attached a certificate of liability insurance, a certificate indicating Worker Compensation coverage, the fee of <br />$125.00, and a copy of the d'tsposal faciliTy disclosure %rm. <br />Applicant's Signature <br />h �. <br />Ti e <br />1 J��.9=�-��_ <br />Date <br />