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��TY of Application for Auto Dismantling License <br />Ior23�1 S <br />14669 Fitzgerald Avenue North, Hugo, MN 55038 (651) 762-630,7 wv*.ci.hugo.mn.us <br />APPLICANT INFORMATION <br />Name Z ,r/� d/� Work Phone <br />Address ./":i /-< /" Home Phone <br />Cell Phone <br />PROPERTY INFORMATION <br />Street Address i'/' /J� xj�J/;/ <br />Legal Description <br />Zoning Cl <br />Has a Special Use Permit been issued for this on the property? If yes, when? , Y171? <br />FEE OWNER INFORMATION <br />Name �y Cc� �!f T/% Work Phone.p�/� <br />Address <br />ADDITIONAL INFORMATION REQUIRED <br />Home Phone <br />Cell Phone <br />• Written consent of the fee owner if different than applicant lvlxi©y-33( <br />• Copy of the current Minnesota Pollution Control Agency Industrial Storm Water permit for the site <br />• Copy of a current Washington County Hazardous Waste Generator License for the site <br />• Site Management Plan for the site in accordance with Chapter 42, Article IV of the City Code At! FltC <br />CERTIFICATION <br />I (we) hereby certify that the information contained in this application, including enclosures, is true and correct to <br />the best of my (our) knowledge. <br />Applicant Signature(s)Date <br />Date <br />