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g�'+'� �;�" I <br />�_. � _, ..J <br />c�ry of Ros���i�� <br />Finance Department, License Divisian <br />2660 Civic Center Drive, Rosevilie, MN S5i l3 <br />(65l ) 792-7036 <br />lZecycling I3au�er I�icense Appliea�ion <br />Fee Dtte: �125.00 Year _��jO (Licet�se will be €az Jas�ua:�y l to Decembcr 31.} <br />Biisiness �lamc ( ���U ���: . ,5'��e.+.TRItv u[i �; � _ <br />Busicicss Address �c���c�,� ��/$ /i/�'u:�c,�T .Li.c� 550�'.� <br />Bustncss Phone (� s/ �,;��a —.��i "7 <br />Co��tact Perso�� .¢.v i 1� ar� y M y' ��'� En�ail Address � n�� <br />E��ier�,�ei�cy Co¢��act Information A- ����� � M �� f��= fc <br />If completec� license should be ���ailed somervhere other thar� the business address, please attach separate sheet. <br />IZecyclit�g ser�rices will be provided to (clieck all that apply); <br />IZcsidentiai '�'Co�zimercial ✓` Mtiltifamily t� Industrial <br />1���un6er of vehicics the applicant proposcs to use in t17c collcction oi recyclables <br />I�ame and ac�dress of cazipasiies ar materrals reco��ery facility where recyclables wi11 be deiivered: <br />Nc�tivsprrJ�r * <br />j� a c fC-T�' � r� c a� p <br />� � �o �t%_ �- �t3 �5 � R u � <br />S i 1}A� � �ti° <br />Office pa��ct/Bo_rbaurd* <br />� p 4 K� l�.c� �u cT <br />Glass * <br />CurrugUted CurdBaard* <br />� o c l:�i,�,�,� c o I� f.� <br />*Required itetl�s for resfdential and multifaEnily haulers <br />Cans/Plastrc * <br />d. - ��c ac�.�r <br />� 0 7 ��� � c'fi�,kr�:-� <br />.5T �t7.$��� M•,a ssir�"S <br />Otltej�(pleatie speci�v) <br />I havc U�e.n provided with a copy c�f the City of Rc�sevillc C�srbside Recycli�iS Ordina��ce and understand that violation oia�ly of the <br />provisions included in the ordinancc may res�ilt in susp�nsio�� or re��ocation of thc liccnse. <br />[ have �ttaclie.d a certificare of lia6iiity i�isura�ice, a certificate indica�ing Wo:-ker Co�npeilsation coveragc, and the fee of � 125.00. <br />/l � `LJ�� � - 11��7��� _ � w y � � �— <br />Datc A�splrcani's Sign�iturc Title <br />