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���� <br />� <br />Finance Department, License Di�vision <br />2660 Civic Center Drive, Roseville, MN SS113 <br />(651) 792-7036 <br />Recycling Hauler License Application <br />Fee Due: $125A0 Year G� �/� (License will be for J'anuary 1 to Deceinber 31.) <br />Business Name `� �i y''�C 7'� K �c.DE.u.�-/ ��C/Y7 i�jJiS r�,dL L� E.1tf>+ �' � <br />Business �►ddress �DC �� �iFl I� � �,,.�lif.tJlG/C � �fc51 ST- �`-'i/Ic.LL� � . � � //�'' <br />�usinessAhone [�.�r�' ']F.��%- �%�� <br />Cantact Person � Email Address <br />Emergency Contact Informatian '�i E.; �- �i FA1N <br />If completed license shoUld be mailed somewhere other than the bnsiness address, please attach separate sheet. <br />Recycling services will be provided to {check all that apply): (� 1.�t.in.3 ��?fCE �• /�!� `�� £�. <br />❑Residential ❑Commercial ❑Multifamily ❑Industrial`�'�n� �-`S 1� - 9'L��O c�iElrXi -�i7�iN <br />Nuinber af vehicles tlse applicant proposes to use in the collection of recyclables _ <br />Name and address of companies or materials recovery faci�ity where racyclahles will be deli�ered: <br />Ne�vsprint* Glass * Carrs/Plastic * <br />O�ce paper/Box6oara'* <br />Carreagated Cardboard* Other(please spec�J <br />o I n1� � <br />*Required items for residential and multifamily haulers <br />I have been provided with a copy of the City ofRoseville Curbside Recycling �rdinance and-understand tliat violation of any of the <br />provisions incluc�ed in the ordinanae may result in suspension or revocation of the license. <br />I have attached a certificate of liability insurance, a ificate indi a' g Worker Compensation coverage, and the fee of $125.00. <br />�_�'- / � . _ I�L • 1% �i� _�D� <br />Date Appli ant's Signa e Title <br />