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2. Introduction

   In order to receive your business license, you must complete the form in compliance with Senate Bill 205.

4. Title II Compliance
   In accordance with the requirements of Title II of the Americans with Disabilities Act (“ADA”) of 1990, the Fair Employment & Housing Act (“FEHA”), the Rehabilitation Act of 1973 (as amended), Government Code section 11135 and other applicable codes, the City of Modesto (“City”) will not discriminate against individuals on the basis of disability in the City’s services, programs, or activities. For more information, please visit the City of Modesto website.
6. Submission of this form is required when applying for or with an annual renewal of a City of Modesto Business License*

   1. I understand that this must be completed with City of Modesto business license applications or annual renewals.
8. Are you applying for a new business license or renewing your annual license?*

   1. Annual Renewal
   2. New Business License
9. Provide your Business License Account Number*
   Your account number can be found on your Declaration of Gross Receipts form.
11. Is your business located outside the City limits of Modesto?*

    1. Yes
    2. No
13. Physical location address inside the City of Modesto*
15. City*
16. State*
    -- Select One --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
17. Zip Code*
19. Physical location address where business is based*
    For businesses located outside of the City limits of Modesto
21. City*
22. State*
    -- Select One --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
23. Zip Code*
25. Provide the primary Standard Industrial Classification (SIC) code(s) for the business activity in Modesto. *
    Look up your SIC Code(s) for the business type. To find your code(s) search by keyword(s). (For example: metal recycling) OR request the SIC code(s) from your insurance broker. Separate each SIC Code with a comma.
27. Do any of the Primary SIC Codes from above match any of the regulated SIC codes listed on the Water Board website?*

    1. Yes
    2. No (Permit not applicable)

    Look up the SIC Codes for your business.
29. Has the business already obtained an Industrial National Pollutant Discharge Elimination System (NPDES) Permit?*

    1. Yes
    2. No

    If you do not have a permit, you cannot continue with submitting this form. For more information contact the Local Regional Board (1-916-464-4764) or State Water Board (1-866-563-3107).
31. Waste Discharge Identification Number (WDID)*
32. Waste Discharge Identification Application Number*
34. No Exposure Certification (NEC) Identification Number*
35. Notice of Non Applicability (NONA) Identification Number*
37. Declaration*

    1. I declare under penalty of perjury under the laws of California that the above information is true and correct to the best of my knowledge.
39. Submitter Name*
40. Title*
42. Business Name*
43. Phone Number*
44. Email Address*
Leave This Blank:


46. 1. Receive an email copy of this form.
47. Email address

    This field is not part of the form submission.

48. Submit

* indicates a required field