APPLICATION FOR CONNECTICUT
MOTOR VEHICLE JUNKYARD LICENSE |
STATE OF CONNECTICUT |
DEPARTMENT OF MOTOR VEHICLES |
K-91 REV. 6-2002 |
DEALERS AND REPAIRERS SECTION |
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INSTRUCTIONS: |
On The Web At ct.gov/dmv |
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1.The applicant must complete Part A and attach newspaper clipping of Advance Public Notice to this application.
2.The Local Approving Authority must complete Part B.
TO: DEPARTMENT OF MOTOR VEHICLES, DEALERS & REPAIRERS SECTION, 60 STATE STREET, WETHERSFIELD, CT 06161
PART A - APPLICANT INFORMATION
NAME UNDER WHICH BUSINESS OF APPLICANT IS TO BE CONDUCTED
FULL ADDRESS OF LOCATION FOR WHICH LICENSE IS REQUESTED (Use separate application for each location)
MAILING ADDRESS (If different from above address)
IS LOCATION VISIBLE FROM A STATE HIGHWAY? |
ROUTE NUMBER |
IS LOCATION VISIBLE FROM INTERSTATE HIGHWAY? |
ROUTE NUMBER |
YES |
NO |
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YES |
NO |
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TYPE OF OWNERSHIP
INDIVIDUAL
IF INCORPORATED OR LLC, UNDER LAWS OF WHAT STATE?
IF APPLICANT FIRM IS OWNED BY INDIVIDUAL OR PARTNERSHIP, ENTER DATA BELOW FOR ALL OWNERS. IF APPLICANT IS A CORPORATION, ENTER DATA FOR PRINCIPAL OFFICERS. IF APPLICANT IS A LLC, ENTER MANAGING MEMBER(S) OR MANAGER.
NAME OF OWNER, PARTNER, PRINCIPAL
OFFICER, OR MANAGING MEMBERS
I declare that the statements made by me in this application, or in any documents attached hereto, are true and complete to the best of my knowledge and belief.
SIGNATURE OF OWNER OR AUTHORIZED OFFICER |
DATE SIGNED |
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CERTIFICATION |
X |
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Subscribed and sworn |
PLACE SWORN |
DATE SIGNED |
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to be before me: |
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SIGNATURE OF NOTARY PUBLIC, JUSTICE OF PEACE, COMMISSIONER OF SUPERIOR COURT |
DATE COMMISSION EXPIRES OR JURIS NO. |
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X |
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PART B - CERTIFICATE OF APPROVAL FOR PROPOSED LOCATION
The firm or individual named above is granted approval to conduct a motor vehicle junk yard business as referred to in Sections 14-67g and 14-67i of the Connecticut General Statutes. A public hearing on this application has been held as indicated and as provided by the Section 14-67k, C.G.S. It is hereby certified that the applicant is deemed suitable to establish, maintain or operate a junk yard business and to receive a license.
In issuing this certification and, at time of hearing referred to below, the following requirements of Section 14-67k, C.G.S., were considered and no basis or sufficient reason was found for disapproval of this application. The board has taken into consideration:
1.That the location is not in an established district restricted against such use as provided in Section 14-67s, C.G.S.
2.The nature and development of surrounding property.
3.The proximity of churches, schools, hospitals, public buildings or other places of public gatherings.
4.The sufficiency in number of other such dismantlers or businesses in the vicinity.
5.The health, safety, and general welfare of the public.
CERTIFYING AUTHORITY OR OFFICIAL
MAJORITY OF BOARD OF SELECTMAN
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SIGNATURE |
TITLE |
SIGNATURE |
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LOCATION |
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X |
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SIGNATURE |
TITLE |
SIGNATURE |
TITLE |
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APPROVAL BY |
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AUTHORIZED |
X |
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X |
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OFFICIALS |
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SIGNATURE |
TITLE |
SIGNATURE |
TITLE |
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X |
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X |
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