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/�. <br />L�� � <br />`��„ J , J J J <br />Finance Department, License Division <br />2660 Civic Center Drive, Raseville, MN 55113 <br />(651) 792-7036 <br />Recyc��.ng Hauler License Applzcation <br />k'ee Due: $125A0 Year �I <br />Business Name <br />Business Address <br />(L,icense wi�l be for ]anuary 1 to December 31.) <br />� <br />• „ <br />Business Phone �`�,�' t!V�r �Q�l� . ... <br />Contact Person �4a� �V�(, �� � Email Add�ress <br />Emergency Contact Informa�ion I 11Qi I Vel� �� ��� �D� I�Ih�l�i'I�i[1�1 ,U[��/y L� r <br />If completed Iicense shoald be mailed somewhere ather than the business address, please attach separate sheet. <br />Recycling services will be provided ta (check all that apply): <br />❑Residential [}'�ommercial [�Giultifamily [�ndustrial <br />Number of vehicles the applicant proposes ko use in the wllection of recycEables <br />Name and address of companies or materials recovary facility where recyclables wii� be delivared: <br />wsprt * <br />`������ <br />O�ce paper/Boxboard* <br />� <br />��nct.�r �.�,� <br />. . .. <br />, <br />� �� �: �� � .,� � � ,� <br />Corrcagated Cardboard* <br />��o�►� � <br />*Required items for residential and multifamily haulers <br />Other(please spec�) <br />I have been provided with a copy of the City of Roseville Curbside Recycling Ordinance and understand that violation of any of the <br />pro�isions 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, and the fee of $125.D0. <br />1� ' Ll'! 3 � I�,! � C.� a <br />Date pplicant's Signature Title <br />