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k i <br />Finance p rtment, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792 -7036 <br />Recycling Hauler License Application <br />Fee Due; $125.00 Year a\ Ai (License will be for January 1 to December 3 1. <br />Business Name <br />• *� 4 <br />Business Address �� <br />cox <br />Business Phone 4,�; - 'A -� --) <br />r <br />Contact Person ��.r -trail Address <br />Emergency Contact Information rv,�k �,�-c <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 />6&sidential RLommercial Wultifamily b4ndustrial <br />Number of vehicles the applicant proposes to use in the collection of r cyelables <br />Name and address of companies or materials recovery facility where recyclables recyclable will be delivered: <br />Newsp <br />4 r <br />Office rl&x oard ` <br />V--4� us'. 1-1(r\ , <br />Glass* 4 Canslplasfc <br />Corrugated Cardboard* <br />`Required items for residential and multifamily haulers <br />t r l specify) <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 />provisions included in the ordinance may result in suspension or revocation of the license, <br />1 have attached a certificate of liability insurance, a certificate indicating Worker Compensation coverage, and the fee of $125.00. <br />-�F , R�-t � , L- � <br />Date Applicant's Signature Title <br />