Agenda - 05-02-1983 - Laserfiche WebLink

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OFFICE USE 061 Species Animal Type Date Received .... Initials of Persons who f;:z checked in form ORANGE COUNTY APPLICATION FOR PERMIT TO KEEP WILD ANIMALS(s) Use Separate Form For Each T .e Wild Animal Kept U. To Six Animals Of Sarno Type May Be Listed On This Form 1. Owner(s) Name: A. Owner(s) Address: (If on Rdral Route, include Road Name) B. Owner(s) Home Telephone : C. Owner(s) Work Telephone: D. If Owner is a Corporation: Name of Corporation: State incorporated in: Names and Addresses of principal officers: Name: Address: E. If owner is any other type of organization: Name of organization Address of organization: —— Names and I.address of principal officers, directors, trustees, or man- aging officials or partners: Name: -- Address: F. What is the owner's purpose in keeping the animal(s): G. Describe owner's qualifications to care for the animal(s) (Such as any training) 2. Name, home addresses and telephone number of person(s) responsible for care of animals (If other than owner): Name: 1 Home Address: ---___--___- _____