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`�� n <br />� <br />City af Roseville <br />Finance Department, License Divisian <br />2660 Civic Center Drive, Roseviile, MN 55113 <br />(651) 792-7036 <br />l�ecyc�ing Hau�er License �pplicaiion <br />Fee Due: �125AD Year <br />Bissiness I�'•ame J �a �i `� <br />(License �vill be for January ] to December 3 J.) <br />BLIS111(:54 f1C�C�ieSS �v + Cf� .NL� b �.� 1.. . �,� � �...,w+�„� /Kvi . �r./'/ � � <br />a��si�,��s >>������ <br />�s j- Y�7 . ��`yc. <br />Co:itact Person ��-�7 � Z� e,�' '�� _ EEnail Address �„ � <br />_�t . z.: �.R� �►--G. /¢p� t/t��,�..c:3 G.� � <br />Emcr,�ency Cantact l�ifonai�ition . - � _.___ �...,-.- ...... . '. T � ` .�, _, . <br />licompleted license should be mailec� somewhere otf�er than ti�e busi��ess �cidress, please attaeh separate sheet. <br />Recyclir�g scrvi�ces �vil] be provided to (chcck all that apply): <br />Rcsidc��tial �nnnercial Multifai�tily {:idustrial <br />Number of vehicles the a�plicant E�roposes €o use i�� the coliection of recyc�ablcs <br />]�'ame and address of com�aiiies ar materials reco��ery facility ���he:-e recyclables wil] be delivered: <br />Nc }nsp,-i,r r * <br />� .�i L � w_ _ ���►,/t� + ,q� ` � <br />� Ya � 1�.G�.,. �� � s-�. <br />��S r� n • S 5 `�' � <br />Of/ice papef�/Box6oal�d* <br />l � <br />Class * <br />Cor-r•cigated Cardhoard * <br />*Requircd itetns far residenti�l and �r�ultifamily haulers <br />tit <br />Cans/Plas7tc * <br />Other(pleuse specif}�) <br />� � <br />[ ha.ve 6een provided witl� a copy of tE�e City af Roseviile CuF-bside Recycltt�g Ordinance and ui�c�erstand #��at violation of any of the <br />provisians included i�� the ordinanec may :-esult in s��spensic�n or rcvocal�on of Ekte license. <br />] l�ave attacl�ed a certificatc of liabiiity instu�ance, a certificaCe indicating Worker Compensation coverage, and the fee of 5125.00. <br />j0-�2,�—v4 ��-��- <br />��...+� �t��.�. �- <br />Datc °� A�plicai�t's Signat�u-e Titic <br />