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APPLICATION <br /> SAN JOA iUIN COUNTY REFUSE COLLECTOR'S LICENSE <br /> THIS APPLICATION MUST BE ACCOMPANIED BY A CASHIER'S CHECK OR MREVOCABLE <br /> LETTER OF CREDIT IN THE AMOUNT O $20,000.(Please print or type.) <br /> 1. Business Name Phone- <br /> 2. <br /> homa2. Business Address <br /> (Address) (City) (Zip Code) <br /> 3. owner(s)Name Phone <br /> Home Address <br /> (Address) (City) (Zip Code) <br /> 4. County Business License Number <br /> I hereby certify under penalty of perjury that the above information is true and correct to the best of my knowledge and belief <br /> Dated <br /> SIGNATURE OF LICENSEE OR AGENT <br /> FOR COUNTY USE ONLY <br /> DEPARTNXNT OF PUBLIC WORKS <br /> 1. Received by Date <br /> 2. Deposit/Letter of Credit received. [ ] Yes [ J No <br /> 3. Applicant holds current County Business License. ( j Yes [ ) No <br /> 4. Applicant has submitted proof of adequate Workers'Compensation and <br /> Casualty Insurance. [ ] Yes [ ] No <br /> 5. Applicant has submitted required financial statement. [ ] Yes [ ] No <br /> 6. Reviewed and recommended for approval by: <br /> FOR COUNTY USE ONLY <br /> ENVIRONMENTAL REALTf1 DEPARTMENT <br /> I. Received by Date <br /> 2. Applicant has the ability to comply with all applicable County regulations and ordinances and State Law. <br /> t ] Yes I ] No <br /> 3. Reviewed and rec4mmended for approval by: <br /> BOARD OF SUPERVISORS <br /> COUNTY OF SAN J'OA UIN,STATE OF CALIFORNIA <br /> B- <br /> REFUSE COLLECTOR'S LICENSE NO. <br /> POST IN A CONSPICUOUS PLACE <br /> A license to collect recyclable materials within the unincorporated area of the County is hereby issued to <br /> . This Board Order shall constitute such license. The licensee shall conduct its <br /> operations under the license in accordance with all applicable Iocal ordinances,rules and regulations and State law. This <br /> license is subject to revocation by this Board,is non-transferable,and is issued for an indefinite period of time. <br /> I hereby certify that the above Order as passed and adopted on by the following vote of the <br /> Board of Supervisors,to wit: <br /> AYES: <br /> g •d d8bt21 ED 62 Rew <br />