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Group Gare Facilities <br />Zoning Ordinance Amendment <br />Page 10 of 12 <br />APPLICATION FOR <br />GROUP CARE FACILITY <br />REGISTRATION CERTIFICATE <br />Regulations are applicable to group care facilities housing three (3) or fewer persons who are <br />unrelated to the proprietor of the establishment [Standard Industrial Classification (SIC) <br />Industry Group # 836; Industry #8361 (Residential Care)] <br />NEW RENEWAL: AMENDMENT: <br />ANNUAL FEE MOM (FEE SHALL NoT F PRO-RATED) <br />ED) <br />EXPIRATION DATE DECEMBER 31 ST OF EACH YEAR <br />(SUBJECT TO RENEWAL BY 12 /15 OF EA. YEAR) <br />ORDINANCE #: ? ? ? ? ? ? ?? Effective ? ? ? ? ?? <br />- -- PLEASE PRINT LEGIBLY -- <br />ADDRESS OF FACILITY: <br />FACILITY NAME: <br />OWNER' S NAME <br />MAILING ADDRESS: <br />CITY /STATE/ZIP: <br />CONTACT NUMBER(s): <br />NIAXIMUM # OF PERSONS HOUSED: <br />