Required fields are marked with asterisks (*)

Mow To Own Application

All applications, licenses and permits are subject to approval.

Name of Applicant

Address

Phone Number

Email Address

Address of property being maintained

Mark one of the following options

I represent a registered 501(c)(3) Non-profit Organization

I own and occupy the adjacent property

Have you failed to pay property taxes within the last three years?

Yes

Have you received a notice from the City in the last two years stating you are in violation of city ordinances?

Yes

Have you had your water service disconnected due to nonpayment within the last two years?

Yes

If you answered yes on numbers 2, 3 or 4 please explain

Date

I certify that the information provided is true, accurate, and complete. I understand that the completion of this application does not guarantee approval

Yes

For Office Use Only

Inventory Number:

PIN: