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UCENSEE: EST, NAME: ADDRESS: APPLICATION FOR LICENSE Anoka County Community Health & Environmental Service Department COURTHOUSE - ANOKA, MINNESOTA 55303 47.2-7063 Thomas C Sauter Sauter & Sons, Inc. 14050 Azurite Street Ramsay, MN 55303 LIC.FEE: TELEPHONE: 42t-7919 EST. NO.: AS PROVIDED BY THE ORDINANCES OF ANOKA COUNTY, I, Thomas C. Sauter MAKE APPLICATION FOR A LICENSE TO OPERATE A Recycling. of concrete and aspt-~lt for crushing,. ESTABLISHMENT AT THE LOCATION STATED HEREIN =OR THE PERIOD OF 5 veals SUBJECTTO All PROVISIONS OF SAID ORDINANCES. 1. State here the MN, Bus. ID or Individual Social Security No.: 4926094 2_ Stats the tega] status of the licenses. Is ths licensee a: X corporation; a) If the licensse is a corporation stats hsrs: Co~om~e Nares: Sauter & Sons, Inc. individual; -- psrtnership Corporate Address: 14050 Azurite Street Co~o~te Presi~snt: Thomas C. Sauter State oftncorporation: .M~_tlne s ota b) If the licensee is a pannership state here the name end aciclress of the partners: Regardless of type of_licensee (corporation, individual proprietorship, partnership, etc.) state here information concerning the individual locally responsibls for the management of this establishment: a) Name: Thomas C. Sauter b) Res. Address: 3121-129th Lane Coon Rapids, MN..55.488 c) Res. Telephone: 421-6152 Have there been any changes to the establishment during the past year?, Yes No X , If yes, descritDe APPLICATION DUE: Late Penalty Fee - If the It z~plication is received after the due date below, a penalty, ee must also be submitted as follows: 10% of the license ee if not more than 7 days late; 20% of the license fee if more then 7 days late but not more than 14 days late: ~qd 30% if more the! 14 d~v~ late. Applj~al~ Signature & Ti,~ (Owner or Corporate Officer) Date