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��.�� `� <br />���� <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651)792-7034 <br />Recycling Hauler License Application <br />��e �br_ S 13 €,66��'�gr ,: �'k+� (License will be far January 1 to December 31.} <br />I�LiJI IL'!�7: �'� =1CIL' _ �.���yl � �+L, '•Y �t1 '�%s f _ <br />-5 iSl�����. S�iY�lf� I��n. stitrr�� <br />BusinessAddress.�.0 �ti� �;�� <br />Business Phone %(A� � 7 t�G •• S�'�[y �-� <br />Contact Person ��� � 3 L-�itft•57=�.�� Erata�� Address <br />Emergency Contact lnforn <br />If completed license should be mailed somewhere other than the business address, please attach separate sheet. <br />Recycling services will be provided to (check all t�aatapply): <br />��;ti }I�CI_� �� � �L 4'IIfI:C�l,l+�� _ :�� �I.I Irj.Yl I� } ,�-' �I7�'I$ITI�I <br />Number of vehicles the applicant proposes to use in the collection ofrecyclables <br />Name and address of companies ar materials rceovery facility where recyclabtes will be delivered: <br />Newsprint�` Glass* Cans�I'lastic'* <br />L. � �? �1 <br />_ �.2���f-�� �j{��� t �Y�{�c�C.�sir ;�-� :� �� _ ��'� � f�a:.e�t?:f� <br />�— { <br />O�ce paper/�oxbaard'� Corrugated Cardboard * l7ther(please speeify) <br />��� �{� � '�� �ff�w'^f^�. <br />�,� . � �.— -t�.�� � <br />*Required items for residential and multifamily haulers <br />I have been provided with a copy of the City of Roseville Curbside 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 Warker Compensation coverage, and the fee of $125.�0. <br />�``� '� • <br />—��. f�� r.;t �,.1:.��t - - }�••.� <br />- �r�_��.� � �: �,���� �'aft� � <br />