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�� i <br />.� <br />City of Rosevi�le <br />Finance Department, License Division <br />2660 Civic Center Drive, Roseville, MN 55113 <br />(G51) 792-7036 <br />Recycling I3auler License Application <br />Fee Dt�e: �125.00 Year �� [� �� {License will be for January 1 to December 31.) <br />Business Name <br />Business Address <br />i� ���� � <br />�� <br />` J � <br />Business Phone <br />Coniact Person �� �� ��j ��},�(' ���j(� Email Address , � -�'�`� <br />Emerge��cy Co��tact lnformation ��1(�(�Q,�S ����� _ <br />If eompleted license shoulct be maiied somewhere other than the business address, please attaeh separa#e sheet. <br />Recyciii7g ser�ices will be proiided to (check �ll tl�at apply): <br />�Residential �Commercial J� Mtiltifamily ]ndustrial <br />Number of vehicles tl�e applicant proposes to use in the collecT.ian of recyelables ___�' __ __ <br />Name and address of companies oi' materiais recovcry facility where t-ecyc�ables will be delivered: <br />N wspri� t * <br />�tt� � ���c� �� _ <br />ZI� �� �� � <br />�,nv�� ��� ��a���5.�� <br />Office puper/Boxboar-rl* <br />���� �� <br />* Ca�rs/1'lasti * <br />L1�t�����.�� �h�� C. L <br />� <br />� m� rn� <br />Cnr•f•uguted Car•d6oai•d * Other(please specify) <br />a �i � �C� U� � <br />*Reqtiired items for residential a��d EnultiFa�tliIy haulers <br />I liave been providec3 with a copy of [he City of Roseville Ct«�bside Recycling Ordinance a��d unders[and that violation of any of the <br />provisions included isi the ordinance may result in suspcnsioi� or revocation of tl7e license. <br />1 have attached a certificate of liability insuran t, certif cate ' i� Worker Compensatio�7 verage, and tlie f of � 125.00. <br />� � � a St <br />Date Applicant's Signatur Title <br />