Food Establishment Permit Application

Lincoln County Health Department

Food Establishment Permit Application

This form must be filed at least 30 days prior to event.

Food Establishment and Contact Information

Food Service Establishment or Organization Name:

Mailing Address of Food Establishment:

City: Zip Code:

Phone Number:

Fax:

Email:

Date of Event: Time of Event:

Location:

Type of Food Establishment:
(The definition of a Temporary Food Establishment is one that operates for a period of no more than 14 consecutive days in conjunction with a single event or celebration.)

Applicant Name:

Mailing Address of Applicant:

City: State: Zip:

Phone Number:

Fax:

Email:

Food Establishment Manager if other than owner:

Address of Manager:

City: State: Zip:

Phone Number:

Fax:

Email:

Type of Food Served

List food being served:

A Permit to Operate will be issued to the applicant after:

A) A properly completed application is submitted.
B) The required fee, if established, is submitted.
C) A plan review session, § 8-201.11, is complete and plans approved.
D) A preoperational inspection shows that the establishment is built or remodeled in accordance with the approved plans and specifications, and the establishment is in compliance with the Lincoln County Food Service Sanitation Regulations 3-23-1998.

The applicant attests to the accuracy of the information provided in this application. The Applicant affirms that he/she will comply with the requirements of the Lincoln County Food Service Sanitation Regulations as established by the Ordinance dated 3-23-1998. The Applicant agrees to allow the Regulatory Authority access to the establishment as specified under § 3-203.12 and 5-205.13 and Subparagraph 8-201.14(D)(6) and any other information required by law.