Get UT Food Service Health Permit Form

Food Service Health Permit Application Environmental Health Services Division Davis County Health Department 22 South State Street Clearfield UT 84015 801-525-5100 TDD 451-3288 Fax 801- 525-5119 Please fill in the information below. Contractors should use owner s information Establishment s Name City Zip Code Days and hours of operation Invoice Information Name Address/P. O. Box City State Zip Code Mailing Information Owner or Corporation Information Phone Address/P. O. Box Individual Partnership L*L*C. Corporation Property Information Requested permit will be issued only after a satisfactory pre-opening inspection has been conducted and the required permit fee has been received* Operating a food service establishment prior to permit issuance other than an authorized renewal procedure is a Class B Misdemeanor. Applicant agrees that maintenance of a health permit is predicated on compliance with the Davis County Food Service Sanitation Rules and Regulations. This permit is revocable for non-compliance. I agree to comply with all laws governing food service in Davis County. Signature of Applicant Do not write below this line-for office use only Plan Review Permit Fee Date Paid Receipt Amount Paid. Contractors should use owner s information Establishment s Name City Zip Code Days and hours of operation Invoice Information Name Address/P. O. Box City State Zip Code Mailing Information Owner or Corporation Information Phone Address/P. O. O. Box City State Zip Code Mailing Information Owner or Corporation Information Phone Address/P. O. Box Individual Partnership L*L*C. Corporation Property Information Requested permit will be issued only after a satisfactory pre-opening inspection has been conducted and the required permit fee has been received* Operating a food service establishment prior to permit issuance other than an authorized renewal procedure is a Class B Misdemeanor. Box Individual Partnership L*L*C. Corporation Property Information Requested permit will be issued only after a satisfactory pre-opening inspection has been conducted and the required permit fee has been received* Operating a food service establishment prior to permit issuance other than an authorized renewal procedure is a Class B Misdemeanor. Applicant agrees that maintenance of a health permit is predicated on compliance with the Davis County Food Service Sanitation Rules and Regulations. Applicant agrees that maintenance of a health permit is predicated on compliance with the Davis County Food Service Sanitation Rules and Regulations. This permit is revocable for non-compliance. I agree to comply with all laws governing food service in Davis County. This permit is revocable for non-compliance. I agree to comply with all laws governing food service in Davis County. Signature of Applicant Do not write below this line-for office use only Plan Review Permit Fee Date Paid Receipt Amount Paid. Contractors should use owner s information Establishment s Name City Zip Code Days and hours of operation Invoice Information Name Address/P. O. Box City State Zip Code Mailing Information Owner or Corporation Information Phone Address/P. O. Box Individual Partnership L*L*C. Corporation Property Information Requested permit will be issued only after a satisfactory pre-opening inspection has been conducted and the required permit fee has been received* Operating a food service establishment prior to permit issuance other than an authorized renewal procedure is a Class B Misdemeanor. .