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2004_1206_Packet
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2004_1206_Packet
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■ � � J � <br />City of Roseville <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(651) 490-2212 <br />Recycling Hauler License Application <br />Fee Due: $125.00 Year ,�f�G..``,'' (License will be for January 1 to December 31.) <br />Business Name ��c,,� ���,� ��'__�j�� ��,5 <br />Business Address .5������ ��C' <br />��,� ��� � ��� � <br />Contact Person ���}+�+'� ,� ������ � �usiness Phone � �' ���'�e} "' � � � <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 that apply): <br />Residential � Commercial X Multifamily �' Industrial <br />Number of vehicles the applicant proposes to use in the collection of recyclables � <br />Name and address of companies or materials recovery facility where recyclables will be delivered: <br />��� ���i�t <br />�� �� �,:� � "� <br />���� �����T' � <br />�� �`�'�t � w�A' �� f�`G#f� <br />�uss+ %r,rsf�� t;�� <br />�� � '��'fi�+ .�� i�'�� �C7'+���.`�x�d� <br />�_-, � �� <br />Off ce paper/Baxboard* Corrugated Cardboard* <br />f f,�� ��+�'f���+�C�� • � � �i��� "' ���• _ <br />_ � <br />--- . �r�� ��'�`r'1� � .�� �''4�[� <br />-- -- .-- � �� �'� � �r� � - <br />*Required items for residential and multifamily haulers <br />Othe�•(please �pecify) <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 Worker Compensation coverage, and the fee of $125.00. <br />, � � � <br />�� �1e �4p IrtBn['s �i�en�Ure � + 7iifo <br />
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