Application for Mobile Home Park License

Application for Mobile Home Park License
Park Name
Number of Lots
Fee
Name of Applicant

First NameLast Name
Address of Applicant

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Location of Mobile Home Park

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Land Owner, (if leased, lease term and expiration date)
Current Mobile Home Park plan to be submitted with the application showing the Park layout, numbered spaces, roadways, service facilities, ect., in accordance with Chapter 4 of Town of Somers Ordinances or Chapter 4 of the Village of Somers Ordinances, whichever applicable.

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Please attach plan Cancelof
Number of Mobile Home site or spaces being applied for under this permit
Minimum lot size, exclusive of roadways or park service areas for spaces being applied for
Has applicant previously operated a Mobile Home Park?
Has applicant at any time been convicted in this State or elsewhere of any crime?
If yes, nature of crime and jurisdiction where crime was committed
Is applicant a corporation?
If yes, list State of Incorporation, names and addresses of Officers and Directors of Corporation
Name of Park Operator

First NameLast Name
Address of Park Operator

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number of Park Operator

Area CodePhone Number
Email of Park Operator
example@example.com
Brief description of water supply and sanitary facilities (municipal, private, ect.)
Signature
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Return application and fee to:

Village/Town of Somers

Village/Town Clerk

PO Box 197

Somers, WI 53171
FOR OFFICE USE ONLY
Date application received

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Date of Board action

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Building Inspector Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Fire Inspector Date

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Date Issued

MonthDayYear
2 digit month, 2 digit day, 4 digit year
Plan Commission referral date

MonthDayYear
2 digit month, 2 digit day, 4 digit year(If Required)
Should be Empty: