Online Form - Permit Application

Asterisks (*) indicate required fields

Click on the Save Changes button when you have finished completing this form.

Application Date *

Type of Permit *

Public Swimming Pool / Spa

Food Service

Animal Establishment

Name of Establishment *

Address *

City *

State *

Zip *

Billing Address (If different)

City

State

Zip

Phone *

Email *

Name of Owner *

Owner Address *

City *

State *

Zip *

Owner Phone *

Owner Email *

Name of Operator *

Operator Address *

City *

State *

Zip *

Operator Phone *

Operator Email *