Fillable LICENSE APPLICATION FOR RUBBISH AND GARBAGE REMOVAL MUNICIPAL (City of South Bend)

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LICENSE APPLICATION FOR RUBBISH AND GARBAGE REMOVAL MUNICIPAL (City of South Bend)

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The LICENSE APPLICATION FOR RUBBISH AND GARBAGE REMOVAL MUNICIPAL (City of South Bend) form is 3 pages long and contains:

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For all municipal business license questions, contact: City of South Bend • Department of Community Investment
227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021
LICENSE APPLICATION FOR – RUBBISH AND GARBAGE REMOVAL
MUNICIPAL CODE SECTION - 4-48
DEFINITION:
Anyone who intends to collect, transport, or dispose of, for compensation, any garbage, rubbish
or trash of any kind, type, or nature. Vehicles owned and operated by the City of South Bend
are not subject to the licensing requirement.
GENERAL INSTRUCTIONS:
1. Print legibly and complete all sections to ensure efficient processing.
2. Assemble all required information and materials before filing application.
3. Thoroughly review all applicable Municipal Code Sections listed above.
4. Licenses expire April 30.
5. Add 10% to license fee for renewal after April 30.
6. Include $5.00 license application fee payable to City of South Bend.
7. License fee payable to City of South Bend due at issuance - $60.00 + $10.00 vehicle
inspection fee (fees are per vehicle).
8. Contact Central Services at (574) 235-9316 to schedule the vehicle inspections.
REQUIRED INFORMATION AND MATERIALS:
1. Registration State, Number, VIN, and other required vehicle information.
2. Include a list of the residential customers serviced or to be serviced on a regular basis.
3. Include the location where the applicant proposes to dispose of the waste.
4. All applicants and licensees shall provide a tipping fee receipt(s) from a licensed landfill upon
request.
APPLICATION PROCESS:
1. Submit Application with $5.00 Processing Fee.
2. Division of Central Services and Department of Code Enforcement Inspections, as required.
3. Controller Denies or Approves License.
4. License issued upon approval and payment of the license fee.
5. License Holder may do business with properly displayed plate, decal, or other identification.
1
For all municipal business license questions, contact: City of South Bend • Department of Community Investment
227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021
LICENSE APPLICATION FOR – RUBBISH AND GARBAGE REMOVAL
MUNICIPAL CODE SECTION - 4-48
I. APPLICATION TYPE Check One: New Renewal
II. BUSINESS DATA
A. Business Name:
B. Business Address:
City: State: Zip:
C. Mailing Address (if differs):
City: State: Zip:
D. Business Telephone Number:
E. Business Fax Number:
F. E-Mail Address:
G. Proposed Location where Vehicles will be Parked and Stored:
H. Zoning of Proposed Parking and Storage Location:
I. Location where the applicant proposes to dispose of waste:
III. PERSONAL DATA
A. Applicant's Legal Name:
B. Residential Address:
City: State: Zip:
C. Residential Telephone Number:
D. Cellphone Number:
E. Position with Business:
For Office Use Only
Application Filed Code Enforcement Approval
Application Fee Paid Central Services Approval
Sent to Dept. License Fee Paid
License Number
Decal Number(s)
Not Approved
Reason
2
For all municipal business license questions, contact: City of South Bend • Department of Community Investment
227 West Jefferson Blvd • Suite 1400 S •South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021
LICENSE APPLICATION FOR – RUBBISH AND GARBAGE REMOVAL
MUNICIPAL CODE SECTION - 4-48
IV. VEHICLE INFORMATION
A. Name of vehicle owner (if differs from applicant name):
B. Residential Address:
City: State: Zip:
C. Vehicle license number and issuing state:
D. Vehicle Identification Number (VIN):
E. Vehicle Year, Make, and Model:
F. Number of Licenses Applied for:
Non-Restricted (Proceed to 1):
Restricted (Proceed to 2):
1. If Non-Restricted:
Type of Vehicle:
Quantity of Material held in Vehicle:
2. If Restricted:
Type of Vehicle:
Quantity of Material held in Vehicle:
Type of Material to be Transported:
Type of Covering to be used:
Hours Vehicle will be used to Transport Material:
V. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION
VI. INCLUDE A LIST OF THE RESIDENTIAL CUSTOMERS TO BE SERVICED ON A REGULAR BASIS
VII. AFFIRMATION
I, hereby, certify and affirm that all of the information I have given in this application is true and
accurate to the best of my knowledge. I further certify that I have in no way attempted to
mislead the City in this application by omitting facts known to me. I have read and understand
the regulations of the Rubbish and Garbage Removal license found in the City of South Bend
Municipal Code, Section 4-48.
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LICENSE APPLICATION FOR RUBBISH AND GARBAGE REMOVAL MUNICIPAL (City of South Bend)

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Completed 16 July 2020

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