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���-�� <br />� <br />Finance Department, License Division <br />2660 Civic Center Drive, Rosevifle, MN 55113 <br />�6si� �r92-7a�6 <br />Recycling Hauler License Application <br />Fee Due: $125.Q0 Year U� {License wi116e for January�l to Deg�6er 31.} <br />Business Name <br />Business Addre <br />Business Phone <br />Contact Person <br />Ernergency Contact Information ��i��] �,��,j � _ .. _ <br />If completed license shauld be mailed somewhere ott�er than the business address, please attach separate sheet. <br />Recycling services will ba provided to (ckeck all that app�y): <br />�]Residentia] ►�Commercial �Multifamily ❑Industrial <br />Number ofvehicles the applicant propases to use in the collection af recyclables y <br />Name and address of companies or materials recovery facility where recyclables will be delivered: <br />�, D Npy� fnn�l�i ���_ n= Glass* �� � Cans/Plastic* <br />�l i ti'l4f <br />� <br />�� � l J i _ <br />3 �� I � � <br />� <br />O�ce paper/Boxboard* Carrugated Cardboard* Qther(please specify) <br />��„ _ _. � <br />*Required ikems :For residential and multifamily haulers <br />I have been provided with a copy of the City of Roseville Cwbside Recycling Ordinarice and understand that violation of any of the <br />provisions included in the ordinanee may result in suspension or revocation of the license. <br />Z have attached a certificate of Iiability ixisur e, a certificate indicating Worker Compensation coverage, and the fee oi$125.04_ <br />��-��—f3 = s� <br />Date Applicant's Signat��re Tit e <br />