Junk

TOWNSHIP OF MUDDY CREEK

PO Box 239

Portersville, PA 16051

Office: 724-368-3438 Fax: 724-368-3432

APPLICATION FOR JUNKYARD PERMIT

Name of Applicant:

_________________________________

Address of Applicant:

_________________________________

Phone Number:

_________________________________

Address of Site:

_________________________________

Tax Parcel #:

240 - _____ - _____

Acres:

_____________________

Estimated # of Cars:

____________

Resident of Muddy Creek Township:

_____Yes _____No

Permit Valid From:

January 1, _____

December 31, _____

The above name person hereby applies for a permit to engage in business as a Junk Yard dealer in the Township of Muddy Creek and hereby certifies that they intend to operate only one place of business within the township and to abide by all the provisions and conditions of Ordinance #12 of Muddy Creek Township, Butler County, Pennsylvania passed on the 10th day of June 1964. The applicant acknowledges receipt of a copy of Ordinance #12.

________________________________

___________________________

Applicant Signature

Date

TOWNSHIP USE ONLY:

Date Received:_____________________

Amount Pd: _______________________