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Get NY Group Child Care Site Inspection Request Form 2014-2024

PPLICANT (Pursuant to Article 47 of the Health Code of the City of New York) (Permit Application Fee Submission Required Prior to Inspection) PLEASE PRINT ALL RESPONSES WHERE REQUIRED 1) NAME OF APPLICANT: 2) NAME OF PERSON WHO ATTENDED THE PRE-PERMIT ORIENTATION: 3) NAME OF CHILD CARE SERVICE (DBA) IF APPLICABLE: 4) SITE ADDRESS AND APPLICANT CONTACT INFORMATION: Building No.: Street: Borough/Town: Tel No.: ( Zip: ) Fax No. ( ) (where you may be reached at all times) E-Mail Address: .

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