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“ ” ’ Outdoor Dining Permit Application Engineering Services Department P.O. Box 642 Modesto, California 95354 [PHONE REDACTED] Modestogov.com For Staff Use Only TRAKiT Case No: Date: To avoid delays with issuing your permit, please ensure that this application is filled out, in its entirety. This includes attaching all required documents. GENERAL REQUIREMENTS Applicant: The applicant will be considered the primary point for all contact, and correspondence from the City unless other arrangements are made in writing. Name/Company: Contact Name: Address: City: State: Zip: Phone: Email: Business Information: *Corporate partnerships must provide a list of principals Business Name/Company: Business Owner Name: Address: City: State: Zip: Phone: Email: Is the business owner the 24 hour contact: ☐ Yes ☐ No If no, Business Contact Name: Phone (24 Hour) Insurance on file with LDE? ***if no, please completely fill Business Section Above ☐ Yes ☐ No City of Modesto Business License Number: City of Modesto Business License Expiration Date: ABC License Type/Number: ABC License Expiration Date: Property Owner Information: ☐ Same as Business Owner? Name: Contact: Address: City: State: Zip: Phone: Email: In accordance with the requirements of Title II of the Americans with Disabilities Act ( ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of Modesto (“City ) will not discriminate against individuals on the basis of disability in the City s services, programs, or activities. For more information, please visit the City of Modesto website at ---PAGE BREAK--- TYPE OF APPLICATION (check all that apply) ☐ Restaurant or Bar ☐Outdoor – Public Sidewalk ☐ Winery or Brewery (Serving Food) ☐Outdoor - Parklet ☐ Retail or Commercial Business DAYS/HOURS OF OPERATION: Sunday From: Monday From: Tuesday From: Wednesday From: Thursday From: Friday From: Saturday From: To: To: To: To: To: To: To: Alcohol sold after midnight? □Yes □No CONSTRUCTION/RENOVATION: Describe any construction, renovation or other improvements planned for building and the timetable for completion. Will permanent barriers be installed? □Yes □No If yes, please provide a detailed description of the materials. What are the dimensions? Do you have permits for this work? □Yes □No If NO, have you applied and when? DECLARATION If the owner is a trust, partnership, LLC, the signature shall be a corporate officer. Attach additional sheets if necessary. I, declare under penalty of perjury that the foregoing is true and correct. I understand and agree to the following: that any false or incomplete information provided by me in connection with this application constitutes cause to either deny the requested permit or revoke the permit if granted, and if this permit is granted, I must update any information should it change, and all of the provisions set forth in Modesto Municipal Code section 4-15 et. seq. a copy of which I received as a part of this application package, and this permit, if granted, is not transferrable and will be revoked upon transfer or sale of the business. I, hereby certify that I am the applicant in the foregoing application, that I have read the foregoing application and know the content thereof and state that the same is true and correct to the best of my knowledge. Applicant (Signature) Applicant (Print Name) I declare that I am the owner of the herein described property and that I familiarized myself with this completed application and give consent to the action requested. Owner (Signature) Owner (Print Name) SIGN SIGN