Fillable Waste Hauler License (Charter Township of Waterford)

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Waste Hauler License (Charter Township of Waterford)

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U.S.A. forms for Charter Township of Waterford

BROWSE CHARTER TOWNSHIP OF WATERFORD (MI) FORMS

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CHARTER TOWNSHIP OF WATERFORD
CLERK’S OFFICE
5200 Civic Center Dr. Waterford, MI 48329
Phone 248-674-6266 Fax 248-674-5455
Web Page www.waterfordmi.gov
WASTE HAULER LICENSING APPLICATION
1 | P a g e
1. Contact Information
NAME
ADDRESS
CITY
STATE
ZIP
EMAIL ADDRESS
2. Name and Location of Business/Applicant
NAME OF BUSINESS
ADDRESS
CITY, STATE ZIP CODE
BUSINESS PHONE NUMBER
BUSINESS FAX
E-MAIL
PARCEL NUMBER AND ZONING IF LOCATED WITHIN WATERFORD TOWNSHIP
3. Days of the Week and Hours of Operation
HOURS OF OPERATION
DAYS OF THE WEEK
This license will be held by
Individual (Attach copy of any Assumed Name Certificate)
Partnership (Attach a copy of Partnership Certificate)
Corporation (Attach a copy of Articles of Incorporation)
Limited Liability Company (Attach a copy of Articles of Organization)
CLERK’S USE ONLY
Annual Waste Hauler License Fee: $100.00
Date Received: Non-Refundable Application Fee Paid
Application Review:. License Number:
2 | P a g e
4. Complete the following information on all owners partners and stockholders with a 10% or more ownership
interest that will be involved in the operation and/or management of the proposed licensed business,
members, and managers (use attach additional sheets if needed):
COPIES OF MOTOR VEHICLE OPERATOR’S LICENSES MUST BE ATTACHED FOR ALL
OWNES, PARTNERS, STOCKHOLDERS, AND MANAGERS
NAME
TITLE
PHONE NUMBER
ANY OTHER NAME OR ALIAS THIS INDIVIDUAL HAS BEEN KNOW BY
DRIVER’S LICENSE NUMBER
ADDRESS
DATE OF BIRTH
CITY
STATE
ZIP CODE
LIST ALL FELONY AND MISDEMEANOR CONVICTIONS
ARRESTING AGENCY
DATE
LIST ALL FELONY AND MISDEMEANOR CONVICTIONS
ARRESTING AGENCY
DATE
NAME
TITLE
PHONE NUMBER
ANY OTHER NAME OR ALIAS THIS INDIVIDUAL HAS BEEN KNOW BY
DRIVER’S LICENSE NUMBER
ADDRESS
DATE OF BIRTH
CITY
STATE
ZIP CODE
LIST ALL FELONY AND MISDEMEANOR CONVICTIONS
ARRESTING AGENCY
DATE
LIST ALL FELONY AND MISDEMEANOR CONVICTIONS
ARRESTING AGENCY
DATE
NAME
TITLE
PHONE NUMBER
ANY OTHER NAME OR ALIAS THIS INDIVIDUAL HAS BEEN KNOW BY
DRIVER’S LICENSE NUMBER
ADDRESS
DATE OF BIRTH
CITY
STATE
ZIP CODE
LIST ALL FELONY AND MISDEMEANOR CONVICTIONS
ARRESTING AGENCY
DATE
LIST ALL FELONY AND MISDEMEANOR CONVICTIONS
ARRESTING AGENCY
DATE
3 | P a g e
5. Attach a copy of each license issued by the State of Michigan to the proposed licensee and provide the
following information for each license.
‘TYPE OR NAME OF LICENSE
LICENSE NUMBER
DATE OF LICENSE
6. Attach a description of the waste hauler services provided by reference to the types of properties single or
multi-family residential, commercial, industrial, or other use), the method of collection (curbside pickup,
dumpsters, or other), and the frequency of service for each type of property and method of collection.
7. Attach :
A list of the vehicles and other equipment to be used in providing the waste hauler services, that for
each vehicle and piece of equipment, includes the following information:
(1) Description of the size, weight, and purpose or use.
(2) Year, make, model, and for vehicles required to be licensed, the license plate number and
month of expiration, and proof of insurance.
(3) A copy of the most recent governmental inspection certificate or report.
8. Attach:
A list of the sites of generation for which waste hauler services are being provided, that for each site
includes the following information:
(1) The address and customer name.
(2) The type of property (single or multi-family residential, commercial, industrial, or
other use.)
(3) The method of collection (curbside, dumpster, or other.)
(4) The frequency and scheduled day of collection or service.
(5) If the services being provided have been paid for in advance, the date through which services
have been paid for and the date of the last payment.
9. Attach a schedule of fees and charges made to customers for waste hauler services.
10. Attach proof of commercial general liability insurance.
THE UNDERSIGNED APPLICANT ACKNOWLEDGES AND AGREES TO COMPLY WITH THE DESIGNATED RESIDENTIAL WASTE
HAULER PROVISIONS IN DIVISION 1A OF CHAPTER 9 OF THE WATERFORD TOWNSHIP CODE OF ORDINANCES AND HEREBY
SWEARS THAT ALL OF THE STATEMENTS, ANSWERS AND INFORMATION I HAVE PROVIDED IN OR AS PART OF THIS
APPLICATION ARE TRUE, ACCURATE AND COMPLETE TO THE BEST OF MY KNOWLEDGE. AND I UNDERSTAND AND
ACKNOWLEDGE THAT ANY FALSEHOODS OR MISREPRESENTATIONS CONTAINED IN SUCH STATEMENTS, ANSWERS OR
INFORMATION CAN, AMONG OTHER THINGS, BE THE CAUSE OF A DENIAL OF THE REQUESTED LICENSE AND CAUSE FOR
THE REVOATION OF ANY LICENSE ISSUED TO THE APPLICANT UNDER CHAPTER 10 OF THE WATERFORD TOWNSHIP CODE.
DATE: _______________ SIGNED:
PRINT NAME: __________________
Subscribed and sworn:
_______________ County, Michigan Acting in _______________ County Notary Public
My Commission Expires:
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Waste Hauler License (Charter Township of Waterford)

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Completed 5 August 2020

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