Revised 4/2014
CITY OF PORTAGE
MOBILE HOME PARK LICENSE APPLICATION
License Fee:__________
Receipt #:____________
To the Clerk of the City of Portage: Application is hereby made for a license for a mobile home park.
Owner’s Name: ___________________________________________
Owner’s Address:__________________________________________
Owner’s Telephone:________________________________________
Location and legal description of Mobile Home Park________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
Number of spaces:_______________
The undersigned agrees to comply with and be bound by all the laws, ordinances, rules, regulations and penalties
covering the business for which the license is applied. The license expires on June 30, ______.
Date:_________________________ _____________________________________
(Signature of Applicant)
For Office Use Only
Department Approval:
Department
Approval
Denied
Signature/Date
City Clerk
City Treasurer
Director of Public Works Utilities Manager
If denied, explain reason: ____________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
________________________________________________________________________________________________________________
E-mail address____________________________________________
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