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�� <br />� � M1 _' <br />� <br />- •- �� <br />.� <br />� • ':.,��x.,: }�:- <br />— ���� • <br />' �• 1 <br />� �. <br />�' � � • _ _ <br />�� <br />�'ari� �f 1�����i�l� <br />Finance Department, License Division <br />2660 Civic Center Drive, Ras, e�vii��, NIN 55113 <br />(651) 792-7034 <br />Recycling Hauler License Application <br />Fee Due: $12a".dD Year �• L� � i� (Y.ic�nse wil[ be for January 1 to becember 31.} <br />Business Name � ��� fl�l I�Kp��� � ��,�� �,� •7� �+ <br />Business Address DUMPSTER BOX S�f3V��;�� <br />a���,rt . <br />Business Phone ��• ����5 _ �•"'�; ���������'$ <br />Contact Person ���C�� � . ������� �mail Address <br />If completed ticense should be mailed somewhere other than the business address, please attach separate sheet. <br />Recycling services will be provided to (check all that apply): <br />�}�cs`.�orrtia] � �'mm�r��i�l �1:�1�i f�m�lu ln��:sa��� <br />Number of vehicles the applicant proppse� tause in the collection of recyclabi�s `'f <br />Name and ad�ire�s a%:compar�ies or znak�riats recovery facility where recyclables will be delivered: <br />�CF!�'S�+FJrli � <br />�� ����� -- <br />Offtce paper/Boxboard * <br />��a � �� ^ ��� �� <br />� r�� <br />���r� �'��a�F�a�rle * � <br />� �� � .�.f ���-11 _. —_�,�.. �r r��.���� <br />Corrugated Cardboard* <br />_... �� .��;��� <br />*Required items for residential and multifamily haulers <br />Dther(pCease specify� <br />�� <br />I have been provided with a copy of the City of Roseville �urbside 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'W rker Compensation coverage, and the fee of $125.00. <br />�C.7 —� l/—U�S"" ��.� � � — <br />Date Applicant's Signature Title <br />