VILLAGE OF MAZON
Application for Business License
Date:
The undersigned hereby makes application for a local business license under the ordinances of the Village of Mazon and makes the following statements of facts and representations in support of such application. This application is made on behalf of and the place of
(Name of Business)
business to be .
Mazon, Illinois
1. Applicant’s full name: Date of birth:
Address of applicant:
Driver’s license number:
Corporate FEIN# (if applicable) Telephone number:
2. Full names of other partner(s) if applicable:
3. The character of my business is:
4. Length of time applicant has been engaged in this business is:
5. Have you been convicted of a felony within the last ten years? yes no
6. I certify that I have reviewed the licensing requirements and am not disqualified from receiving a license for any reason. yes no
7. Has a previous license issued by the State of Illinois or by the Federal Government ever been revoked? yes no
If yes, give reason:
8. Do you state you will not violate any of the laws of the State of Illinois, the United States and of the Ordinances of the Village of Mazon, Illinois, in the conduct of your business?
yes no
9. Is the business to be conducted by a manager or agent? yes no
If yes, supply name and address:
Phone number: cell:
10. Do you own the premises wherein the business will be operated under the license applied for here? yes no
If no, attach a copy of the lease and answer the following:
Name and address of landlord:
Phone number of landlord: cell:
Expiration date of lease:
11. Business License Fee: $25 Date fee paid:
DO NOT WRITE BELOW THIS LINE
* Was an inspection done on the location? yes no
* If yes, by whom? Date:
Inspection notes:
* Does the business listed above fit the description of a permitted use in the zoning classification for that location? yes no
* If NO, does it fall under a special use? yes no
(Inform zoning board of proper classification)
{}Application Accepted
{}Application Rejected. Why
Zoning Officer Signature:
{}Special Use Permit Required Date
{}Special Use Permit Obtained
NOTES:
(Ord. 2010-04, passed 4-19-2010)