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' � <br />� <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, �N 55113 <br />(651) 792-7034 <br />Recycling Hauler License Application <br />Fee Due: $�25,40 Year �G(_> � (License will be far January � to December 31.) <br />�u��rw:��:i�� <br />�3usi�ess Address �� ������� � ���� � �' ��� <br />����������'— — — <br />Business Phone �� ���H ��• <br />Contact Person ���fL� �,��%,� f /!�'C�� �mailAddress � <br />,� _. . <br />Emergency Contact Infarmation �t C,�c�` � ° �!��� ��F� �s — <br />If completed license should be mailed somewhere other than the business address, please attach separate sheet. <br />Recycling services will be p��+`�: J 10 (check all that apply): <br />, _�Residentiat ~° Catnmercial�MGit�fami�y �ndustriaf <br />Number of vehicles the applicantproposes to use in the collection of recyclables ,./ <br />Name and address of companies ar materials recovery facility wE�c;re recyclables will be delivered: <br />' 1� �ti'�'�Fdyr� �7�' 1�� ��srs' �'.i�af�'��,�rtiC' <br />[� ' � � �J�-� [�a+�5.� J'��� ���_� . � ��rp�' � <br />O�ce paper/,�oxbaard � <br />— ��� ��� ������ — <br />Corrugated Cardboard* <br />� �� �� -� ����{.� �_..1 <br />*Required items for residential and multifamily haulers <br />Odher{plenss specify) <br />���`� ��f "�� - <br />---���` ��.. .�}`� �����-� �� <br />I have been provided with a copy of the City of Roseville Cu�'bside Recycling Ordinance and understand that violation of any of the <br />provisions included in the ordinance may result in suspension or revocation of the license. <br />I have attached a certificate of liability insurance, a certificate indicating Worker �cr�.;rJBe coverage, and the fee of $125.00 <br />°} r .� • <br />4 �F-�.--t��, {�'�,_,a_.•�� �" �� ���— ��a � ������-_--r" <br />r��-�---• - <br />Date Applicant's Signature �'Title <br />