Laserfiche WebLink
t3uubdi nt ou t3 <br />��r►"� �.__ . _ �1 <br />��rr k_ J 1 � J <br />City of' Roseville <br />Finance De��artnient, Lice��se Division <br />2660 Civic Certter Drive, R€�sevilic, M]\ 55l l3 <br />(65l) 792-7036 <br />Recycling I�auler License Applica�ion <br />Fcc UuC: �12ti.U(M Ycar �o �Q (License tivill bc fi�r.lai�uary i to Dccc�ziber3l.) <br />Busiilrss Name � �'1/tvr ���,�] (nQ.-i 1G�� _ _.._ __ <br />E3usincSSAcidecss �`7��J T��l/�.�(}�[�.F° � _ �,W�/��i� <br />�L1Sit7C55 �y�7C71iC f.�'7 1' (� J �' <br />Co3itact Person l.�¢ r1�� � �,�(�!� E=mail Address <br />' J <br />Emergency Contacl Information <br />1! conzplcted liccnse should be ma�led sumetivhere otl�c�� Eliai� the be�siness ac[�iress, plc�se atE,�ch se�aratc shcef. <br />Ren�clin� s�r��ices �4�i11 be provided to (chcci� all that apply): <br />ltcsidentia! 'f Comincrcial il�ultifanzily y fiidustriEil <br />�'umbcr nf vehicics tlie �}pplicant pro�ioses to usc in the collcction of recyclablcs <br />1�'.ame ai�d address of can�panics or nt�tcrials recovery faciiity ���I�erc recyc�a�les �vili be delivered: <br />R'c tvspriirr * <br />QJJice perpc�!/L3o.r6oard * <br />Glusc * <br />C'orru�rrtctl Ccrrcl6ar�rd* <br />*Rcquirecl itc�ns Fnr residcniial and n�ultifamily haulers <br />Cu��s/Plrrstrc * <br />01ker(pleuse spec�rfj`) <br />[ have 6cei� pro�°i�ded u-itl� a copy o1 the City of Rose��iile C'urb�sicle ]tccycGng Ordinance and understand that ��ioiatioi� of a�ny o-f tl�e <br />provisions includec3 i�n the ordint�nce may result in suspension or rc��ocatioai of ttic license_ <br />I fia.ve attached a certifzcate of li�bility iiasuranec, a certilicate ii7clicattng Worker C:ompei�sation coverage, and tiie fee of $125.00. <br />_�.�?4� 1 U f ���----_ �vsJ� C/`�N�?.�. ILlA7J%.—�Y� <br />Da c ApplicanE s isntaitire Ticle <br />� � � �� �� <br />