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St •’ “ -r- • -•nf'V ■ ■ — »?»>ri?ro>:y7 ’5-^^.'-’Ti'TT •; ■v'“'i'!:V -V V <br />czTz ' oioao <br />F.O. Box 66 <br />Crystal Bay, MN 55323 <br />473-7357 <br />License Tear I f <br />r- V - ^ ^Date Received <br />Fee Paid L'O-^ Initials <br />gADHACg 4 refuse COLLECTOR'S LICENSE APPLICATION <br />The undersigned wishes to operate the indicated business in the City of Orono and <br />herewith nutkes application for a license to do so. <br />R 4 W Roll-Off Service. Inc <br />5525 CountT Road 50 <br />(Street) <br />flar vr*r m <br />(City)(State) TZip^^ode ) <br />iOTieeee Phone Voadier 448-7833 <br />l^hppUeent's <br />JIddress <br />Russ Leistlcko % R ft W <br />Saae as above _ _ _ _ <br />(Street) <br />MlMie PiaBber Sane as Above <br />(City):state) <br />l-iV'./l <br />f Check One I _ _ _ _ individual _ _ _ _ Partnersiiip <br />ISlinber of Vehicles to be used in Orono ___f . _ W- _ <br />XX <br />( Z1. p Code ) <br />CITY OF <br />fimi OFFICE <br />— 01 CEH <br />two <br />60.00 <br />ms 7L 60.00 <br />Description of Vehicles (attached list if more): <br />Loaded Loaded <br />Year Mfer. Gross Wt. Rear Axle Wt. Size/Yards License Number <br />HECEIPI Th^ YOUmono coot noi w: <br />05/0^' <br />1980 fkfik 46. <br />1980 rja£k <br />•III! <br />1 34.0•Ill*•II <br />in t rv An vrla YXQS239 <br />in F/\An vric VYOQ'i'in_________________ <br />Ceneral area of City served <br />Eehsdttle of Collection chararea. <br />All <br />waste <br />AppY’OXiniate number of customers in Orono no residential, co o^|ructlon customers <br />P Location of dumping area Hcnr.eplp County. Dem-Con. Wondlaicp — <br />P^*il FOR •nna APPLICATION TO BE COMPLETE, TOO MOST ENCLOSE THE FOLLONXNGs <br />Surety bond in the amount of $1,000. Proof of insurance in the amount of <br />•100,000-$300,000-$50,000, and 10-day cancellation clause. ® <br />630.00 flat rate fee, plus 615/truck, and a $30.00 transfer fee (if applicable^. <br />^ T asi lidiejowner and operator of the above business and I have paid all license fees <br />^ information is correct. <br />Appli^fe <br />\ <br />4^^-?R-Q7 <br />Date <br />POB CITT OSB ONLY: After review of application, staff recommends: <br />^ Approval _ _ _ _ _ _ Denial _ _ _ _ _ _ Other (specify) <br />of city official Date