Food Premises Application Form

Home / Food Premises Application Form

Food Premises Application Form

Owner Name(Required)
Owner Address(Required)
Type of Establishment(s) Applying for (Check all that apply):(Required)
Name of Establishment(Required)
Address(Required)
MM slash DD slash YYYY
Months of Operation (Check all that apply):(Required)
Hours of operation
Hours of operation
Hours of operation
Hours of operation
Hours of operation
Hours of operation
Hours of operation
What type of water supply will service your premise?(Required)
What type of sewage disposal system will service your premise?(Required)
Will you be conducting any of the following activities: canning, curing, dehydrating, emulsifying, fermenting, or smoking of a meat product?(Required)
Will you be conducting any canning/jarring of any food other than meat products? Examples include jams, jellies, sauces, and beverages(Required)
Are you a certified food handler?(Required)
Food service premises where potentially hazardous foods are prepared must have at least one certified food handler present during all hours of operation.
Will you be renting time/space in a pre-existing, approved kitchen facility?(Required)