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R1�� <br />1�� <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651)792-7036 <br />Recycling Hauler License Application <br />� , , , -� <br />Fee Due: �12� Year ��.: ��,� (License will be for January 1 to December- 31.) <br />Busi7essNaine t`� i c�, �) 1.\�.'T�,`��"�� I —t.�-(�:�' <br />J <br />Business Address �� 2--�1 P���'l��c� c��,�� V 1 �-'le•�� ��---c�� � �G'1 Gil � �� � � �Zdt <br />� u � <br />� . ..-. � <br />Business Phone ', �' �`'; ; <-� J , �'�'��`� <br />Contact Person ��(' �c,�i �-� �� 1 �=i 1 Email Address ,� �C� 5 �, �'- �%'� (.a (Ca t1 �1 r �� , ��x" � t � 4��'•:.���� 1 � �'�%'� <br />� < <br />� , ,' � <br />Emergency Contact Information ���-G' ��-E' i f ��, i 9-�-� � c�.�, !-- �}'� �-`v ,J�� <br />�- <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 ❑Multifamily ❑Industrial <br />Number of vehicles the applicant proposes to use in the collection of recyclables <br />Name and address of companies or materials recovery facility where recyclables will be delivered: <br />Nei�vsprint * Glass �` <br />� � <br />�.�� �� �--f---�� �, �`-� � � <br />Cans/Plastic * <br />Office pape�/Boxbocn�d* Co�•�z�gated Cardboard* Other(please specify) <br />*Required items for residential and m�iltifamily haulers <br />I have been provided with a copy of tl�e City of Roseville Cw•bside Recycling Ordir�ance and understand that violation of any of the <br />provisions included in the ordinance may result in suspension or revocation of the license. <br />I llave attached a certificate of liability insurance, a ce ' icate indic ' orker Compensation covei•a?� d the fee of $125.00. <br />�� �%'�s f� '�%��/ <br />% p ��, � ' � r"� <br />ate Applicant's Signature Title <br />