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<br />, <br /> <br />NORTH CAROLINA DEPARTMENT OF AGRICULTURE & CONSUMER SERVICES <br />VETERINARY DIVISION <br />1030 MAIL SERVICE CENTER <br />RALEIGH, NC 27699-1030 <br /> <br />ANIMAL WELFARE FACILITY APPLICATION <br /> <br />LICENSE APPLICATION TO OPERATE AS ONE OF THE FOLLOWING: <br /> <br />D ANIMAL SHELTER (NO FEE) <br />D. PET SHOP ($50.00) <br /> <br />D BOARDING KENNEL ($50.00) <br />D PUBLIC AUCTION ($50.00) <br /> <br />NAME OF BUSINESS. <br />TELEPHONE ( ) <br />PHYSICAL ADDRESS <br />cm ZIP <br />DIRECTIONS TO BUSINESS (IF RURAL) <br /> <br />COUNTY <br /> <br />MAILING ADDRESS <br />CITY <br /> <br />STATE <br /> <br />ZIP <br /> <br />......................................................................... <br /> <br />TELEPHONE ( ) <br /> <br />OWNER <br />ADDRESS <br />CITY <br /> <br />STATE ZIP <br /> <br />~.....................~.................................................. <br /> <br />CLEANING HOURS: <br />PUBLIC BUSINESS HOURS: <br />NUMBER OF ENCLOSURES: DOGS CATS <br />MAXIMUM NUMBER OF ANIMALS ON PREMISES: DOGS <br /> <br />.....................................................~..................., <br /> <br />DATE. <br /> <br />LICENSE OR REGISTRATION FEES SHALLACCOMPANY APPLICATION. MAKE CHECKS OR . . <br />MONEY ORDERS PAyABLE TO NCDA&CS, ANIMAL HEAL THDIVISION. APPLICANT SHALL <br />FILE A SEPARATE APPLICATION FOR EACH CATEGORY SHOWN ABOVE. <br /> <br />DATE INSPECTED <br />DATE APPROVED ... <br />(ATTACH INSPECTION REPORT) <br /> <br />G'S <br /> <br />.. .. .. <br /> <br />. <br /> <br />INSPECTORS USE ONLY: <br />AW'l 2/04 <br />