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���. <br />�,� J , ,,,,,_ J J 1 <br />Citv of Roseville <br />Fi��ance Department, License Division <br />2660 Civic Center Drive, Rosevilte, MN SS113 <br />{b5I) 792-7036 <br />Recycling I�au�er License Applica�ion <br />ee Due: $125,00 Year ��} j� (Lscense �vill be for Ja:ivary 1 to Dccember 3 I,) <br />Busincss Name � �.� ��"�C — ��..=:-�t � <br />BL€sincss Ac�dress �'� � �� �,`-� � .�i.P✓ � � � � <br />Business E'hone ' ��{? ° � � �� _ ...__ ...._--- <br />� p�. <br />Cont�ict Pcrson �° i�� 5 ��.�' °f ��� Email Address <br />Emergency Coistact InfornZation <br />.�c�-r �"� I <br />It� com�leted license should he mailed some�vhere c�ther thaii the business address, please attach separatc sheet. <br />(Zccyclin� services «�ill be provided to (cficck all tl�at a�ply}: <br />Residcntial �Comn3crcial_�_Multifa�nily �C ]ndustrial <br />I�Eumber of vehicles tfie applicant propases to use it1 the collection of recyclables <br />Nan�e and address af companies or inaterials recovcry facility �vF�ct�e recyclables will be de[ivered: <br />NL'YVS�JI'lf11 * <br />['r �C1S.S * <br />Cans/Plastic * <br />� 1�-1 ! �.�r��l��� ��� � — `�' �� C; fi:�� � = <br />i�C� ��-�c�cjwc�-I �'�-- t�� <br />�a�� �°vi r� <br />Office��ape�/Boxhnard* orrrrgated Card6oui�d* Otlzer(pleasespecif}� <br />*Required items for residential ac�d multifamily haulers <br />1 have bcen pravided with a copy of the City of Rosevilie Curbside Recycling Ordiziance and understand that violation of any of the <br />pravisions i�icluded i31 the ordinance. may result iF� suspensi evo ' i� of tlic license. <br />I have �ttac��cd a ccrtificatc of EiabiJity i <br />�����1� <br />... _........ <br />Date / <br />, a certific�te�dicati <br />Appbi�atlt's Si <br />Compensation covcrage, and the fee of S 125.00. <br />_ � � -�� •c�---- <br />r�c�� <br />