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Application Fee: $150 Per Employee: $6 AMOUNT: TYPE: DATE: Commercial Millcreek Business License Application 3330 S. 1300 E. Millcreek, UT 84106 Phone: [PHONE REDACTED] For more information please visit www.millcreek.us Date: Business License Community Council: APN Business Name: Phone: Business Location: City: Millcreek State: UT Zip: Business Web Address: Business Email: Number of Employees: Type of Business: Briefly Describe Your Business Activities At The Location: YOU MUST SUBMIT THE FOLLOWING ITEMS WITH YOUR APPLICATION: You must provide documents for all fields marked “Yes” below. Yes No Verification that your Business Name has been registered with the Utah Department of Commerce (This document is always required unless the Business Name is your exact legal name.) Sales Tax Number (STC) (When the business sells a product) Employer Identification Number (EIN) (When there are employees, not including the owner or for a Corporation, Partnership or Limited Liability) Property Owner / Manager Authorization (This form must be completed in addition to the business license application for individuals leasing a commercial or residential space. This form MUST be completed by either the owner of the property, a property management group designated by the owner, or the registered agent of the company. This form must be signed in the presence of a notary by the authorized agent, and the date the document is signed must correspond with the date the document is notarized. This form will NOT be accepted if it is signed by an authorized agent prior to the date the document is notarized.) Site Plan (This must include a to-scale building footprint, marking where the business will be conducted with dimensions or square footage, travel ways & on-site parking stalls designated for your business marked. BLUE BOXES ARE FOR OFFICE USE ONLY Date: Business License Community Council: Zone: SEASONAL BUSINESS YOU MUST SUBMIT THE FOLLOWING ITEMS WITH YOUR APPLICATION: OWNERSHIP CHANGE Business Fee Exemption Request * Please note you must attach a copy of any professional licensing related to the business's operations * TEMPORARY BUSINESS Type of Business: NEW COMMERCIAL BUSINESS ADDRESS CHANGE ---PAGE BREAK--- City: State: Corporation Partnership* Limited Liability* (Red requires EIN) OWNERSHIP TYPE: OWNERS NAME: First: Last: Initial: Date of Birth: Address: City: State: Zip: City: State: Phone: Contact Name: Position: Owner Manager Employee Contact Address: City: State: Phone: Email: Applicant’s Agreement: I the undersigned understand and agree to comply with all applicable codes and regulations of the Millcreek Code of Ordinances. I understand that I shall not begin, nor cause to begin, business at this location without first obtaining a business license, which includes passing zoning, fire, building, and / or wastewater or other inspections / reviews as required. I would like my Business License Renewal Form sent to: Owner’s Mailing Address Business Address Corporate Address Please Note: Your business license will expire one year from the date issued, and all licenses must be renewed annually. Any license renewed 30 days after the expiration date will be assessed a penalty fee. As per Millcreek Code of Ordinance, Section 5.16.090 . . it is the responsibility of the licensee to renew the license and failure to receive a renewal statement does not excuse this responsibility. . Applicant’s Signature: Planning/Zoning Approval & Comments Signature: Date: Sale Tax Number (STC): Federal Tax ID# (EIN): Number of Employees: ---PAGE BREAK--- Millcreek 3330 S. 1300 E. Millcreek, UT 84106 Phone: [PHONE REDACTED] For more information please visit www.millcreek.us Property Owner/Manager Authorization Date: Community Council: Application Accepted by: Dated this day of . On the day of , personally appeared before me the signer(s) of the above instrument who duly acknowledged to me they executed same. ---PAGE BREAK--- INDUSTRY DISCHARGE QUESTIONNAIRE New Business Form G Renewal Form G Section: 1 Name of Business: Property Address: (street, city, zip) Mailing Address: (street, city, zip) Contact Person: (Name) Contact Person: (Title) Phone Facility is: Owned: G Leased: G Home Business: G Other: Check the appropriate box’s which may apply to your business or give a brief description below of the business products or service’s provided; Auto-body Auto-repair Auto-sales Car Wash Dental Dry Cleaner Machine Shop Medical Office Only Restaurant / Fast Foods Screen Printer / Printing Warehouse / Storage Other Required; Brief Description of business: Section: 2 Average Number of Employees: Afternoon:__________ Night: Total: Types of Waste Water Discharges; other than SANITARY WASTEWATER (restrooms) check the box’s below which may apply to your business Non-Contact Cooling Water Contact Cooling Water Equipment Wash Down Boiler Blow Down Other Discharges; Explain: List Expected Daily Water Use in Gallons Per Day (GPD): Section: 3 Are any of your process discharges regulated by Federal Categorical Discharge Standards? Yes G No G If yes, list Standards: Code of Federal Regulations (CFR) _ Will any chemicals be used or stored on site? Yes G No G If yes, list chemicals that will be on site in quantities of 55 gallons or 500 lbs or more on the back of this form. Will any hazardous waste be generated at this facility? Yes G No G If yes, list types on the back of this form. Any Questions please call Central Valley Water Reclamation Facility Industrial Pretreatment Department (801) 973-9100 I have personally examined and am familiar with the information submitted in this report and any attachments. Based on my inquiry of those individuals immediately responsible for obtaining the information reported herein is true, accurate, and complete Signature: Date: ( FOR C.V.W.R.F. USE ONLY ) Business Classification: ( ) Is there a (GOSI) Installed at this location: Yes G No G Is a (GOSI) Needed at this location: Yes G No Reviewed by: (CV) Date: ---PAGE BREAK--- CHEMICALS USED CHEMICAL NAME AMOUNT STORED AMOUNT USED HAZARDOUS WASTES NAME EXPECTED GENERATION QUANTITY DISPOSAL METHOD February 25 2015