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Name 1nd address of each transfer station, disposal faciliry and coulpostin� facility used for each of the followii�g: <br />(attach additional pages if needed) <br />Garbage <br />�, <br />�1 ��i...i' 1�'-i �.�.�� � �i'ri�c:. �� i L� "— �,�j�.; ��.�.,� L <br />� ►'Zt,�� �c�.r� �.��P , �- �.Q�.XZ.�.t..� <br />� �_,�. I _�c;�..�,s�. `�fir��� , <br />Yard `VasteBrush <br />� , , <br />��°�C. A.�iy�C.� � � `y:�l`� i <br />Construction/Demolition Debris <br />� �, <br />� <br />�Z �C � �>�_ � �-� �_ �.��ti�� <br />Organics <br />[nclude a copy of the disclosure form used to inform customers of the disposal facilities used by the applicant. <br />Residential Customer Rates <br />Please include all relevant taxes and fees includin� surcharges. <br />Tliese will be published and otherwise made available to residents. <br />Service <br />32 Gallon Service* <br />64 Gallon Service* <br />96 Gallon Service* <br />Walk-up Service* <br />Additioual Garbage* <br />Yard Waste* <br />Organics <br />*These services are required to be offered in Roseville. <br />Cost <br />(per mondi) <br />`� (per u�onth) <br />_���� <br />����-�� ry (per month) <br />(per month) <br />I have been provided with a copy of the Ciry of Roseville Solid �hlaste Collectioil Ordinance and imderstand that violation <br />of the provisions included in the ordinance may result in suspension or revocation of tt�e license. <br />I have attached a certificate of liability insurance, a certificate indicatine `Vorker Compensation coverage, the fee of <br />S 12�.00, ar.d a copy of the disposal facility disclosure form. <br />�—�� <br />A ant's Signature <br />�� (�� � <br />T�tte � <br />(�� lc�� 1� <br />Date <br />