Campground/Mobile Home Park License

Campground/Mobile Home Park License
Name of Owner*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Establishment Type*

CampgroundMobile Home ParkCampground/Mobile Home ParkState, Municipality, or Nonprofit OrganizationPark and Recreation Owned Campground
Number of Lots in Mobile Home Park*
Select which Applies.
Campground - City License #*
Name of Campground*
Campground Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mobile Home Park - City License #*
Name of Mobile Home Park*
Mobile Home Park Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
If there is a change in ownership, provide the name of the former establishment and owner

Note: If this is the first application for license issued by the City of Dickinson, all plans and other documentation is required by ordinance must be submitted to this department before license will be issued. If you have any questions please contact the Building Official Leonard Schwindt at 701-456-7803.
Site Plan(s)*

Cancelof
Emergency Plan(s)*

Cancelof
The undersigned is familiar with the requirements of the campground laws and regulations in force under the law and hereby certifies that the campground for which this application for a license is hereby made will be operated in full compliance with the law and regulations.
The undersigned is familiar with the requirements of the mobile home park laws and regulations in force under North Dakota law and the City of Dickinson Municipal Code and hereby certifies that the mobile home park for which this application for license is hereby made will be operated in full compliance with such law and regulations.
I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this license will be complied with, whether specified herein or not. The granting of a license does not presume to give authority to violate or cancel the provisions of any other state or local law regulating the operation of said mobile home park, trailer park or campground. Furthermore, I grant City Staff access onto the subject property for inspection purposes.
Signature*

Clear
Fee Calc
Date*

MonthDayYear
Date

Should be Empty:

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Expiration Month	Expiration Year