Skip to Main Content
Things To Do
Select a Category
City Manager's Office
Finance Mileage Reimbursement
Fire Department Forms
Planning and Development
Vendor Registration Form
signing in or creating an account
, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.
Sign in to Save Progress
Baytown Custodial Residential Care and Living Permit Application
This form has been modified since it was saved. Please review all fields before submitting.
Facility Physical Address
Facility Mailing Address
Facility Main Phone Number
Facility 24-hour Emergency Phone Number
Driver's License Number and State
Number of Occupants
Description of Services Provided
Facility Owner/Parent Company Name
I hereby apply for a Baytown Custodial Residential Care and Living Permit. I attest that the information contained in this application is true and accurate to the best of my knowledge.
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
Electronic Signature of Person responsible for this Facility:
This application must be submitted and a check made payable to the City of Baytown in the amount of $50 for new facilities and $25 for renewals must accompany the Baytown Facility Emergency Operations Plan. Submit Custodial Care Permit payments online. Submit Forms and Plans via email to OEM@baytown.org
Online Custodial Care Payment
Leave This Blank:
Receive an email copy of this form.
This field is not part of the form submission.
* indicates a required field
Public Meetings & Agenda Packets
Government Websites by
Slideshow Left Arrow
Slideshow Right Arrow