TOWN OF LIVERMORE

APPLICATION FOR AUTOMOBILE GRAVEYARD/JUNKYARD PERMIT

I/We

hereby make application for a permit to establish, operate, maintain an Automobile Graveyard, Automobile Recycling Business and/or Junkyard at the following described location and in accordance with the provisions of Title 30-A, Sections 3751 to 3760, Chapter 183.

Answer all questions in full.

1. Give location of Automobile Graveyard and/or Junkyard

2. Is this application made by or for a company, partnership, corporation, individual?

3. Is this property leased?

Property owned by

Address:

4. How is "yard" screened? - Fence? (Type)......

Height

Trees? (Type).

Embankment?____ Gully?_____ Hill? Other?

5. How far is edge of "yard" from center of highway?

feet.

6. Can junk be seen from any part of highway? Yes No

7. Was Junkyard Law, Requirements and Fees explained to you? Yes_____N______

No

8. Is any portion of this "yard" on public property? Yes No

9. Is "yard" within 300 feet of a Public Park, Public Playground, Public Bathing Beach, School, Church or Cemetery? Yes No

10. When was "yard" established?

11. When was last permit issued?

By Whom?

To Whom?

The undersigned certifies that the above information is true and correct to the best of his/her knowledge and that he/she is the owner or agent of the property or that he/she has been duly authorized by the owner to make this application and to receive the permit under the law.

Signed by:

Address

For:

Name of Company, Corporation, Partnership, Individual

Make complete sketch of "yard." Show footage of all sides and location in relationship to adjacent properties. Show distance (in feet) from edge of "yard" to center of highway. Fill in Route Number or Local Road Name, Name of nearest City/Town in each direction, distance from nearest intersection, bridge or other known reference point.

Circle Correct Direction: N S EW

Tax Map No.

Lot No

Zone

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