Peddling & Soliciting Permit

Honesdale Borough 958 Main Street, Honesdale PA 18431 Telephone: 570-253-0731
Permit Issued Under Chapter 152 - Peddling & Soliciting
PERMIT
PERMIT FEE
PAID
DATE PERMIT ISSUED

MonthDayYear
Date
DATE PERMIT EFFECTIVE

MonthDayYear
Date
DATE PERMIT EXPIRES

MonthDayYear
Date
NATURE OF BUSINESS THAT PERMIT COVERS
APPLICANT
PHONE
BUSINESS PHONE
PRESENT ADDRESS
OPERATION LOCATION IN BOROUGH
DAYS AND HOURS AT LOCATION
DESCRIPTION OF WATER, WASTEWATER AND ELECTRIC SERVICES TO BE UTILIZED
PROPERTY OWNER SIGNATURE

Clear
IF VEHICLE IS USED:
STATE REGISTRATION VIN
LICENSE PLATE STATE
MAKE MODEL
OPERATORS LICENSE
WHERE WILL VEHICLE BE PARKED IN BOROUGH
HAVE YOU EVER BEEN CONVICTED OF A CRIME?
IF YES EXPLAIN
TO THE BEST OF MY KNOWLEDGE, THE ABOVE INFORMATION IS BELIEVED TO BE TRUE AND CORRECT.
SIGNATURE

Clear
PERMIT ISSUED BY
As per Chapter 152 of the Fee Schedule

Residents of Honesdale Borough

$5.00 per year with a 24 hour waiting period $25.00 per day with a 7 day waiting period
Should be Empty:

DESCRIPTION OF WATER, WASTEWATER AND ELECTRIC SERVICES TO BE UTILIZED