Business License Application

General Information

Application Type(Required)
Business Address(Required)
Mailing Address
Days and Hours of Operation(Required)
Days
Open
Close
 
Example
M-F 9am 4pm
List of Vending Machines and Cigarette Sales
Alarm Types

Business Owner Contact Information

Name(Required)
Address

Employee Contact Information

Building Owner / Landlord Contact Information

Address(Required)

Licenses and Documents

If you require one or more Lake County Health Department Certificates, please include that below.
Attach all required State and County licenses held by the Business Owner, Business Manager and employees.
Max. file size: 50 MB.
Signature(Required)

 
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