Form Whl87 - Application For License Refuse Collector And Waste Hauler
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1CITY OF WALKER
COUNTY OF KENT
STATE OF MICHIGAN
APPLICATION FOR LICENSE
REFUSE COLLECTOR AND WASTE HAULER
1. Applicant’s name:______________________________________________________________
2. Applicant’s address:____________________________________________________________
3. Applicant’s phone No.:_____________________________
_________________
__________________
_______________
_________________
Make
Model
License No.
Serial No.
_________________
__________________
_______________
_________________
Make
Model
License No.
Serial No.
_________________
__________________
_______________
_________________
Make
Model
License No.
Serial No.
_________________
__________________
_______________
_________________
Make
Model
License No.
Serial No.
(List additional vehicles on back of page.)
5. Annual Fee $30.00 per vehicle. Amount Paid by applicant $ ____________________________
6. Applicant’s Insurance Carrier_____________________________________________________
7. Certificate of Insurance attached herewith
__________
__________
yes
no
8. I hereby affirm that the above statements are true, and that the equipment used by this
applicant will not endanger the health and safety of the inhabitants of the City of Walker. I
also affirm that I will serve the public in a fair, honest, sage and competent manner and in
compliance with the City Code and all other applicable laws, statutes, ordinances, rules and
regulations.
_________________________
________________________________________
Date
Signature of Applicant
-----------------------------------------------------------------------------------------------------------------------
_____________________________
__________
__________________________________
Approval or Disapproval
Date
City Manager
__________
__________________________________
Date
City Manager
Decals Issued________________ License No.________________ Exp. Date _______________
WHL87
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