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City of Orono <br />Boi 66 (2750 Kelley Parkway) <br />Crystal Bay, MN 55323 <br />(952) 249-4600 <br />License Year <br />Date Received_____ <br />Fee Paid ____Initials <br />Garbage & Refuse Collector's License Application <br />The undersigned wishes to operate the indicated business in the City of Orono and herewith makes applications for a <br />license to do so. <br />Business/Firm Blackowiak & Son, Inc. <br />Address 1195 Sunnyfield Rd. N., Mound, Mn.55354 <br />(Street) <br />Business Phone Number 952-472-3398 <br />(City)(State)(Zip code) <br />Applicant's Name Frank Blackowiak <br />Address 1155 Sunnyfield Rd. N.• Mound, Mn.55354 <br />Phone Number <br />(Street) <br />952-472-2977 <br />(City)(State)(Zip code) <br />Check One:Individual Partnership ^Corporation <br />Number of Vehicles to be used in Orono <br />Description of Vehicles (attach list if more): <br />-Year Mfgr. Gross wt. Rear Axle Wt. Sizc/Yard^ <br />__ ______ ______ (SEE ATTACHED) _______ <br />License Number <br />General area of City served All of Orono except Ferndale <br />Schedule of Collection charges/ dates (SEE ATTACHE D ) <br />Appro-ximate number of customers in Orono 2500_____ <br />Location of dumping area Hennepin Energy Resource Recovery Co., Mpls. Mn. <br />(6UR ins. AGENT WILL ISSUE A CERTIFICATE OF INSURANCE) <br />IN dRDER FOR THIS APPLICATION TO BE PROCESSED, YOU MUCT INCLOSE <br />■ Sur^fv hnnd in the amniinf nf Cl linnSurety bond in the amount of SI,000. <br />Proof of insurance in the amount of S100,000 - S300.000 - $50,000 and I O-day cancellation clause. <br />Annual fee is agS^.Ot) flat rate fee, plus $15.00 per truck, and a $30.00 transfer fee (if applicable). <br />I am the owner and operator of the above business and I have paid all license fees and taxes required by law. I have <br />verified that the above information is correct. <br />4/24/02 <br />Applicant Signature Date <br />FOR CITY USE ONLY: After review of application, suff recommends: <br />Approval . , ____Denial ____Other (specify) <br />Signature of Qtty Officia