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�J� � , <br />j,,••►._. e . __e � 1 <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 `���. � (License will Ue for January 1 to December 31.) <br />Business Name <br />Business Addre <br />Business Phone ��/+ ��'% 3��''� <br />Contact Person �j¢�_Q � G/� Einail Address ���� j/U�/c�/ /YI�S'�% �i�'j <br />Emergency Contact I�it'ormation �{�� �� � . <br />e �ea • "l�4 - / 99� <br />If completed license should be mliled somewhere other th�n the business adclress, please attach separate sheet. <br />Recycling services will be provided to (checic all that apply): • <br />❑Residential ❑Cominercial ❑Multifamily ❑Industrial /���ft�d!_�^s ��i"—! <br />Niimber of vehicles the applicant proposes to use in the collection of recyclables / U ,� ��a � C.r��/� "`-C�">/ <br />Name and address of companies or materills recovery facility where recycl2bles will be delivered: <br />Netivsprin.t* <br />Glass * <br />Cans/Plastic * <br />_ � 4 a . �..- ��F,� J �'� <br />Of/ice pceper/BoxboaJ^d* Corrti�gc�ted Cardboa�^d * Other(please specifj�) <br />� � � �� � <br />*Required items for residential and multifamily haulers <br />I have been provided with a copy of the City of Roseville Curbside Recycling Ordivauce and understand that violation of any of the <br />provisions included 'ul the ordinance may result u� suspension or revocation of the liceuse. <br />I have attached a certificate of liability insurance, certificate indi ating Worker Compensation coverage, and the fee of $125.0 . <br />.e�- �e - �s c� - � � <br />�� <br />Date A licant's S arii e Title <br />����o � � �1,�c.��s ��S - 9,�'°D /�'�J� ' ��S�nuc� <br />� <br />�D • �D��'S <br />` �t.c �( - �'�'�J- �SEQt1lt� <br />��„�l » <br />