HomeMy WebLinkAboutFertilizer Manf Facility Application (2)1
For all municipal business license questions, contact: City of South Bend • Department of Community Investment
215 S. Dr. Martin Luther King Jr. Blvd. • Suite 500
South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021
LICENSE APPLICATION FOR – FERTILIZER MANUFACTURING FACILITIES
MUNICIPAL CODE SECTION – 4-23
I.APPLICATION TYPE Check One:New Renewal
II. BUSINESS DATA
A.Business Name:
B. Business Address:
City: State: Zip:
C. Mailing Address (If different from above):
City: State: Zip:
D. Business Telephone Number:
E. Business Fax Number:
F. E-Mail Address:
G. Zoning of Business Location:
H.Number of Off-Street Parking Spaces available to the Public and Employees:
I.Description of the building to be used:
1.Age of Building:
2.Type of Building Material:
3.Square Footage:
J. Specific Organic Waste to be Processed:
K. Proposed Hours of Operation:
L. Anticipated number of vehicles entering and leaving the facility daily:
M. Anticipated noise and vibration level generated by the facility:
N. Anticipated odor emitted by the facility:
For Office Use Only
Application Filed Public Works Approval
Sent to Dept. License Fee Paid
License Number Common Council Approval
Not Approved
Reason
2
For all municipal business license questions, contact: City of South Bend • Department of Community Investment
215 S. Dr. Martin Luther King Jr. Blvd. • Suite 500
South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021
LICENSE APPLICATION FOR – FERTILIZER MANUFACTURING FACILITIES
MUNICIPAL CODE SECTION – 4-23
III. PERSONAL DATA
A.Applicant's Legal Name:
B.Residential Address:
City: State: Zip:
C.Residential Telephone Number:
D.Cellphone Number:
E.Position with Business:
IV. INCLUDE $5.00 PROCESSING FEE WITH APPLICATION
V. INCLUDE WITH APPLICATION, A SITE PLAN OF THE FACILITY SHOWING PROPERTY LINES, BUILDINGS,
PARKING SPACES, LOADING DOCKS, AND LANDSCAPING
VI.INCLUDE WITH THE APPLICATION, EVIDENCE OF APPROVAL FROM ALL FEDERAL, STATE, AND LOCAL
AGENCIES HAVING JURSIDICTIN OVER CITING CONSTRUCTOIN AND OPERATION OF FACILITY, INCLUDING
COMPLIANCE WITH SECTION 21-04.02 OF THE MUNICIPAL CODE OF SOUTH BEND
VII.ANY ADDITIONAL INFORMATION REQUIRED BY THE BOARD OF PUBLIC WORKS AS TO OWNERSHIP
AND OPERATION OF THE FACILITY
VIII. AFFIRMATION
I hereby certify and affirm that all information I have given in this application is true and accurate to the
best of my knowledge. I further certify and affirm that I have in no way attempted to mislead the City in
this application by omitting facts known to me. I have read and understand the regulations of Fertilizer
Manufacturing Facilities as found in the City of South Bend Municipal code Section 4-23.
Signature Date