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`�� <br />� <br />City of Roseville <br />Finance Department, License Division <br />2660 Ci��ic Center Drive, Roseville, MN 55113 <br />{651)792-7036 <br />l�ecycling IIauler Lieense Applieation <br />Fee llue: S 125,00 Year �'� �{License ���iil bc for January 1 to December 31.) <br />BusinessNamc �LVt�La�cJ �t �j�['j�jf��.. �1�jc� �s'��, <br />Business Address .��w r � 5a � �� � ,� �'1 l��(j� � ��f�,�,�J _ <br />���s����5s ���,��,� (05 i �� 6 - l�� � <br />CantactPci•so�i �j�fl�U� �j�✓i'1 W����t�y�ailAddress �1i�15 (jsC} 4 1Lz����:� <br />Emerge�zey Contact Inlormation �' �� � 2 �1Cj�l �eR�e 1��� ' <br />— �� — _ <br />lf' completed lice�ise shoald be mailed some.��here othcr than the business address, please attaclz separate sheet. <br />Recycling services will be provided ro(check all that apply}; <br />�Rcsidc�ITial ✓Commcrcial ✓Mullifa3niiy ✓]ndiistrial <br />i�umber oFveEiicles tE�e applicant proposes to use i�l the collcctio�i of�recyclables � <br />Namc and address of companies or rnaterials recovcry facility wl�ere recyclables will be delivered: <br />�! , ,� � e s �Gd.rT l.l._ ! ! V 7 \ � GI a.cs * <br />v <br />�S ��r�c0 ST�1� <br />M �s � � � S5� 1 � <br />----_ <br />i 1� <br />OfJirc p�rper/Bo.rboa�•d* Corrirgute�l Cardboai�d* <br />1� ' �� f <br />*Requircd items for residential and multifa�t�ily haufers <br />I have bceii }�rovi�lcd �vith a copy of the City of RosevilJc Curbside Rec� <br />provisions incic�ded in the ordinance »iay result in sus�e �sioi� or rcvocat <br />1 have aftaclacd� a ccrtifieate of liabiliCy i <br />�a - � - oq <br />D <br />a c�ftificat� indi <br />t's Sienatu <br />Ca,�s/Plastic* �j <br />Otl�er(please speciJy) <br />Ordinance and widerstand tilat violation of any of the <br />fhc lice�lsc. <br />mpeiisation co��erage, and the fee of $] 25.00. <br />� e,� <br />Titic <br />