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1.�%�-�: <br />� <br />Finance Department, LiceRSe Division <br />Z660 Civic Center Drive, Roseville, MN 55l X3 <br />{651) 792-7036 <br />Recycling Hauler L�cense Application <br />Fee Due: 5125.00 Year {License will be for January 1 to December 31,} <br />Business Name <br />a� <br />�usiness Address � <br />Business Phone <br />Cantact Person <br />Emergency Contact Information <br />Emai1 Address <br />If completed license should be mailed somewhere other than the business address, please attach separate sheet. <br />Recycling services will be provided to (check all that apply): <br />�Residential �Commercial �ultifamily �Indusirial <br />v <br />Nuinber of vehicles tha app[icant proposes to use in the collection of recyclables <br />Narne and address of companies or materials recovery facility where recyclables will be delivered: <br />r Newsprint * n f_ Glass * ,1Can.s/.Plastic � <br />�1.�1�W�►KA+1 r�►k� i►itT�l15. �1�c1Ck.i � /�s�t�lJ1 <br />/�� � <br />E. - <br />�ce paper/Boxboarc� Corrugated Cardboard� Other(please specify) <br />1�'11!' �'e- � ! <br />,�� - �� �e <br />*Required items for residential and muftifamily F�aulers <br />I E�ave been provided with a copy af the City of Roseville Curbside Recycling Ordinance and understand that violation of any of the <br />provisions included in the ordinance may resu[t in suspension or revocation ofthe license. <br />I have attached a certificate of liability insurance, a certificate ' icati Worker Compensation coverage, and the fee of $125.60. <br />/1�� S''� / �7 4�qr.4�r�c .�4[ <br />�Date li nt's Signature Title <br />