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li�►���I�C�� <br />�. <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 792-7036 <br />Recycling Hauler License Application <br />Fee Due: $125.00 Year �� � L (License will be for January 1 to December 31.) <br />Business Name ��'�'� �� �'PC�i� I lP ^� �1 <br />Business Address _ _� �� �—�� 'P w°/� (� � y�` � ` ; � c✓ f�''� �S� �� � � <br />Business Phone � °� 1 � C'- �� �" �� � C) <br />ContactPerson ��n�`�� �G�k�W�� EmailAddress ('���5�'(�,���`~Q �� �v�ii'� C�'�yC�t�'Ut� •c9r� <br />��—�r-- <br />EmergencyContactlnformation 1.��+=���r� �D�C-'� ����' ��� '� ���� <br />If completed license shoald be mailed son�ewhere other than the business address, please attach separate sl�eet. <br />Recycling services will be provided to (check all that apply): <br />�esidential ❑Commercial ,$.�.Multifainily ❑Industrial <br />�/ � <br />Number of vef►icles tl�e �pplicant proposes to use in the collecfion of recyclables �"� <br />Name and address of companies or materials recovery facility where recyclables will be delivered: <br />Newsprint* <br />Glass * <br />Cans/Plastic * <br />� �� �`�G � P���v� S r 4 � v��P I�U �� ��c� �v �°�f ��j i��CyC�r �J� `� r dc�t�PSSi��� <br />� ' i ' � �l G � r�� �� (�,� � �'2 S' �C��J.a ���� n1 � �,�; �,� r���l; s , �.� s� �I 1'3 <br />Ge C� � <br />Offi.ce paper/Boxboard* Corrzcgatecl Cardboard* <br />*Required items for residential and multifamily haulers <br />Oiher(please specr.'fy) <br />I have been provided witl� a copy of the City of Roseville Curbside Recycliilg Ordinance and understavd that violation of any of the <br />provisions included in the ordinance may result in suspension or revocation of the license. <br />I have attacl� d a certificate of liability insurance, certifica indicatii� orker Coulpeusation coverage, and tl�e fee of $125.00, <br />� �! I L- 4 %s�( ��-I�,��S �1��� <br />ate Applicant's Signature Title <br />