PERMIT APPLICATION FOR COMMERCIAL LANDSCAPERS AND GARDENERS

1.   Name: ______________________________________Tel. # ___________________________

     Corporation/Business Name: _____________________________________________________

2.  Address: ____________________________________________________________________

3.  Applicant's place of residence and/or business for the past five (5) years:

    ____________________________________________________________________________

    ___________________________________________________________________________

4.   NY State Pesticide Registration/License #: __________________________________________

5.   Nassau County Business License #:________________________________________________

6.  Dumping Permit #: ____________________Expiration Date: ____________________________

     Location: ____________________________________________________________________

7.  Have you, any owner, partner or employee of the applicant ever been convicted of a crime?

      ___Yes  ___No    If yes, provide details: ____________________________________________

8.  VEHICLES:  (APPLICANT MUST SUBMIT VALID REGISTRATION FOR EACH)

        Year/Make/Model                                     Plate #                                           Registration Expires

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

10.   Name of the person responsible to the Village for compliance with the requirements of the Village
        Code while performing gardening or landscaping services within the Incorporated Village of Floral Park:

______________________________________________________________________________

Daytime Telephone #: ____________________Evening Telephone #: _________________________

11.   Rules and Regulations to be followed by Licensee:

     (a)  The licensee shall be responsible for the disposal of all yard waste and debris.  No licensee shall place
           any garbage, refuse, cuttings, leaves, wood or other materials upon any public highway or public
           property. All lawn cuttings, leaves and debris accumulated from real property located in the Village
           of Floral Park must be removed by the licensee and disposed of at his/her own cost.
     (b)  No licensee shall scatter or dump any garbage, refuse, cuttings, leaves or other waste material on any
           public highway or public property.  No licensee shall use any mechanical or electrical power device to
           case these items to be scattered on any public highway or public property. 
     (c)  The identification decal shall be affixed to and displayed in the corner of the left front fender of each
           vehicle and on the left rear bumper of any trailer regularly used in the course of business within the
           Incorporated Village of Floral Park.
     (d)  Other:  Refer to this application, the accompanying guidelines and Chapter 44 of the Code of the
           Incorporated Village of Floral Park for other rules and regulations to be followed.
     (e)  Upon approval of this application, a license will be issued which is non-transferable.

12.  I have read this application, the accompanying guidelines and Chapter 44 of the Code of the Incorporated
       Village of Floral Park, all of which govern landscaping businesses within the Incorporated Village of
       Floral Park.

                                                             INDIVIDUAL APPLICANT

STATE OF NEW YORK  §
COUNTY OF NASSAU   §

____________________________________________________, being duly sworn deposes and says,
under the penalties of perjury, that he/she is the applicant above mentioned; that he/she has read the foregoing
application for a license, and knows the contents thereof, and that the same are true to his/her own knowledge.

                                                                                           __________________________________________
                                                                                             APPLICANT

                                                CORPORATE/PARTNERSHIP APPLICANT

STATE OF NEW YORK  §
COUNTY OF NASSAU   §

____________________________________________________, being duly sworn deposes and says,
under the penalties of perjury, that he/she is the ____________________________________
                                                                               Title
of __________________________________________________________________________
                      Corporation/partnership, etc.                                                   
the applicant above mentioned; that he/she has read the foregoing application for a license, and knows the
contents thereof, and the same are true to his/her own knowledge.

                                                                           __________________________________________
                                                                                             APPLICANT

Sworn to before me this __________day of _____________________20 __________.

___________________________________________________________________
NOTARY PUBLIC

APPLICATION DOES NOT NEED TO BE NOTARIZED IF APPLYING IN PERSON.