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;` <br />��� `' a �� � <br />City of �2oseville <br />Finance I�3epartment, License Divisio�x <br />26G0 Civic Center Drive, Rosevilie, MN 551 �3 <br />(6Sl ) '792-'�034 <br />� .: � . .. . � <br />. ' �. �: . , ., <br />�'ee Due: �125.OD 'Yeai° .C..�.s'1�+� (i,icense �,vill be for .ianuary 1 to 77ecernber 31.) <br />Business Name ����� � ��� �,: o <br />l3�siness Address �� � �� � �.�. � ����.� ���. �j �'`�-'�'�- <br />Business Phone � � �j�'" " ��L1�./ � <br />Contaet Persan <br />�mergency Contact Tnformation <br />� En�ail Address <br />� � ��� � � <br />IE'com�leted ticense si�QUld be mai�ed son�awhere other thas� tlie f�us9ness Ad�ress, please attach separats st3eet, <br />Recycling services will be pravided to (clleck a11 thaY ap�ly): <br />�esideEytial�Corrsmercial Muttifamiiy Industrial <br />I�iumber of r�ehicles tlae aPglicar�i �roposes to use in the col[ection of recyctables � <br />Narrse and add��ess of companies or �raaterials recovery facillty where recyclables wiil be detivered: <br />yvsprin t* ass * Cans/.F'lasti c'� <br />A��_ � �,: .. . � , . _ �i.l.! � � <br />����. ��� ..,.,_ <br />Offce papsr/Baxboard* Corrugated Cardboard* �ther(please specify) <br />��� ��- ����. - �` I�i��.-`i`�'i���'�.�. <br />*Required i�ems for residentia� and rt�ult'sfamily haulers <br />� have been provided with a copy of the City of Roseville Curbside Recycling Ordinance and �€nd�rstaud that violation of any of the <br />provisions included in the ordinance may result in suspension ar revacation of the license. <br />1 have attached a certi#"icate af �iabii ity insurance, a certii"icaie in i ating orl<er CompensaEion coveraga, and the fee of $125.0�. <br />�" t,a.� . - �/ ����-�.-����, <br />, <br />I7ake Applicant's Signature Titie <br />