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j�� <br />�.�- <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, NIN 55113 <br />(651) 792-7036 <br />Recycling Hauler License Application <br />Fee Due: $12�.00 Year �� �° (License will be For Janliary 1 to D�cember 3l <br />BL1S1(10SS NA111� <br />Business Adctr e: <br />Business Phone <br />Conract Person <br />Emergency Con <br />If completed license should be mailed some���he►•e other than the business address, please attach separate sheet. <br />Recyclin� ser� ices will be provided to (clleck all tllat apply): <br />❑Residential Commercial - i lultifamily udtiish-ial <br />�1unlber of vehicles the applicant proposes to use iu die collection of recyclables <br />Name and address of companies or materials recovery facility ��here recyclables �vill be delivered: <br />������ �tivspr-int* �, rss* � j n�s/Plrs * � <br />i� ' j" �, <br />Office p�rper/Boxboar�d* Cori�ugntecf Cardboard* � Otl:er/please specif �) <br />�1 ���� ��,p�i _ ��iD��e� ����pe� , I � ' ��— - �.� _ <br />*Required items for residential and multifamily haulers <br />I I�ave been provided �vith a copy of the Ciry of Rosevifle Ctirbside Recycling Ordinance and understand that violatio�l of any of the <br />provisions included 'ul the ordinance may result ul suspensiou or revocation of the liceuse. <br />I llave aTtaclled � certificate of liability insurailce, a certiticate indicatinU Worker Compensation covera�e, and tlle fee of � 125.00. <br />� I" � � � ! � � !/ 1 W/ Jyt.�— � c7 <br />Date App(icant's Signature Title <br />