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��� � <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: �125.00 Year � " <br />� L,C1( �: (License will be for Jan�iary 1 to December 31.) <br />Business Nam� �� �L�'7� � <br />Business Adciress �� �25 � <br />Business Phone �� �' <br />�j�rd�ic�� ���'I����I�.�,��Lk <br />V� <br />Contact Person �� � ' ��'� Email Address c�l �' � , ` �. <br />� �i n i�� � C�Q � �ii11 i�., � L�+ i C� � ��� �> <br />� �. <br />Emet-gency Contact Information �� �� � � �� �-� � ( j �� � <br />If co►npleted license shoi�ld be mailed somewhere other than the business address, p(ease attach separate shcet. <br />Recyclin; ser��ices wi11 be provided to (check all dlat apply): <br />�Residential �Commercial �lultifau�ily ❑[udustrial <br />Nunlber of vehicles the applicant proposes to use iu the collection of recyclables <br />�1ame and address of companies or materia(s recovery facility �vhere recyclables �vill be dclivet•ed: <br />� Vetiv pr-int* <br />' r �����' ;1�\ � <br />Z1 ��� 11 �!'� , '�.�,� <br />��v �. r � ��v � �—��i c�h�5 m � <br />` ��t� <br />Office paper/Bo.�boarcf* <br />� , mP <br />Glnss * <br />Corrugntecl Carcfboru�d * <br />c�� <br />*Required items for residential and tnultifainily haulers <br />� <br />Cnf�s/Plastic * <br />Otl�e��(plea.re speci/j) <br />��`� i'� i'Yl �Q <br />I ha��e been provided ���ith a copy of the City of Roscville Curbside Recycling Ordina�lce and l�nderstand thaC violatioil of any of the <br />provisions included in the ordivance may result in suspension or revocation of the liceuse. <br />I ha��e attached a certiticate of liability inst :�r ce, a certiticate ii� icating Worker Compensatiou coverage, and tl�e fee of $ t2�.00. <br />f �_ ��� _ � ) � �,V ���' l,Li � � � <br />� �'� 11�11 �� l�Lh�'1 V� <br />Date � App(icant's Signature Title <br />.{�SSi�t�1 ri-�- <br />