Laserfiche WebLink
/`"� <br />i` <br />�� � <br />''��'r�, .. �f .�..�d <br />Cit� of Rase�ille <br />Finance I9epa�t�nent, License l���visio� <br />8660 Civic Center �rive, R,osewille, MN 55� 13 <br />{6S1) '�92-'i034 <br />l�ecycl�n� �aule�° L��e�s� .�.pp��ca�ion <br />r�� n��: �1as.oa <br />Rus;ncss Narne <br />ear��� (�,icense wi13 be fn€• January 1 tn IJecerr�ber 3 t.) <br />2C� � t�` �' c3 �1 <br />Business Addrass ' 7�� � • �CJ'�� � � / � <J0. <br />8usioess Phon� �S ° � � '" c�C� � Y <br />ContactPerson���6�cC.�'e�� !FY'��s�l�"�.�W�'". Ema'slAddress <br />Entergency Contact InformaEaon <br />jf cownpleted �i�ense shaui�3 be maiied somewhere other tl�an tl�e business ac3dress, piease aftach se�arate sl�ect: <br />�ecvc[ing services wilt Ge prqvic'ed to (check all that apply): <br />�Reside��tial�Commercial�Zv£uliifamiIy_, �__�_.Tndustrial <br />Nusnber of vei�ictes th� applieaiit prn�oses to use in the eollection of recyc[ables _.,.� _�, �___� <br />I�iame and add�•ess of campanies or materiais recqvery facility where recyc[ables wiil be delivered: <br />Newspri�xd * <br />��s% �L.r^/rt� / <br />O�ce pape�°/l�oxGoard * <br />Glass �` <br />.--�---�---- <br />Cot•rugated CaYdboard* <br />..—�,____._.. . <br />'�Rec�nired items for residential and mutti�amily haulers <br />Cans/Plastic * <br />pther'(please specify} <br />/ � <br />1 llave been pr€�vided wiih a copy of the City of iZpsevalle Curbside Recycling Ori3inance and ut3derstand that vioiation nf any of the <br />pi°nvisions inctuded 'an the ordi3lance may result ir€ suspension ar revoeatipn o�'the licea3se. <br />i liave attaclzed a eertificate o€ liabitity ii�surance, a certi%cate indicating Wark�r Cors�pensat'son coverage, and the %e oi $i25.00. <br />� , <br />%� � � �� .�� �.y..�..�. �--!2�,,,' _ 8�Lr4�C� <br />Date � Applicant's Signature `I'iti� � <br />