NAME OF BUSINESS*

ADDRESS:*

BLACK JACK, MO 63033

PHONE NUMBER*

WEBSITE

EMAIL*

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1. Please submit the completed, signed and dated Business License Application – Home Occupation, along with this checklist.

2. Do you (the applicant/daycare provider) reside in the home in which the day care will be operated? *

YES

NO

3. Are you the owner of the home/ property? If the answer is no, you must obtain written permission from the property owner.*

YES

NO

4. Days and Hours of operation *

5. What is the maximum number of children (under the age of 18) that will be cared for in the operation of the day care at the premises? *

6. Of the number of children set forth in your answer to question #5, how many will be related to you?
“Related" means any child related to you by blood, marriage, or adoption within the third degree, including your children, grandchildren, great-grandchildren, siblings, first cousins, nephews, nieces (step-sibling or half-sibling), nephews, nieces, great-nephew and great-niece.
*

7. Of the number of children set forth in you answer to question #5, how many will be unrelated to you?
If more than four (4), then please provide the child-care facility license issued by the Missouri Department of Health and Senior Service
*

8. Will you have any employees who are not members of your immediate family? *

YES

NO

9. Will you have any employees who do not reside in the home in which the day care will be operated? *

YES

NO

10. The following additional requirements must be met before the City can grant you a business license:
a. No more than 25% of the total floor area of any story of the home may be used for the operation of the day care.
b. No mechanical equipment may be installed for the operation of the day care except for equipment that is normally used for purely domestic or household purposes.
c. No sign may be used at the premises for the business other than one non-illuminated name plate attached to the building entrance which is not more than one square foot in area.
d. No commodity may be sold upon the premises.
e. The home must be in compliance with all applicable building codes.

Applicant must comply with all federal, state, and local regulations pertaining to this subject.

Signature of Applicant

Date