Permit Application Form

Name:    _______________________________________

Address: _______________________________________

Telephone Number :______________________________

City:      _______________________________________

Zip:       _______________

Year of existing permit ____________

You will need two items in order to obtain a permit from Tipton County

Please check the items that you have enclosed

_____    Copy of Driver's License

You may select one of the following for your second proof of residence:

_____    Vehicle Registration

_____    Voter's Registration

_____    Current Utility Bill

_____    Current Property Tax Notice

_____    Other ________________________________________

If you have selected Other from the above list you may be required to submit additional information prior to your application being approved.  Also if you have your current permit please mail it in with the completed application.

Mail the completed form with $36.00 (check only and please include your telephone number) to:

Tipton County Public Works, Permit Application, 8279 Highway 51, Brighton, TN 38011