Follow the steps to fill out the form accurately and submit it on time.

1. Click ‘Get Form’ button to obtain the form and open it in your editor.
2. Begin by completing both sides of the application. Ensure that all fields are filled clearly in black ink or digitally, avoiding any incomplete or illegible entries.
3. In the first section, provide the name of your food establishment as well as the street address, city, zip code, and phone number. Make sure this information is accurate.
4. Indicate the type of ownership for the establishment by selecting one of the options: Individual, Corporation, Non-Profit, Partnership, or LLC. If you select LLC, be sure to submit the necessary proof of ownership.
5. Fill in the billing and year-round mailing address for the owner or corporation. This is the address where permit renewal notifications will be sent, so it is crucial to provide an active and accurate address.
6. Provide an email address to ensure you receive electronic communications regarding your application.
7. Complete the personal mailing address of the person signing the application, making sure to include the name, street address, phone number, city, state, and zip code.
8. If applicable, provide the name and mailing address of your corporation, LLC, or partnership. Double-check that all details are current and correct.
9. Select the type of establishment from the given list by checking the appropriate box. This information is vital for determining the regulations that apply to your food establishment.
10. Specify your water supply source by selecting either Well Water or Public Water. Additionally, indicate your waste disposal system as either Public (Sewers) or Private (Cesspools/leaching fields).
11. If your establishment has seating, indicate the number of seats provided. If not, select 'No' and leave the number field blank.
12. Provide the tax map number and associated district information as required. This data helps in processing your application.
13. Sign and print your name, indicating your title and the date. Ensure that the application is signed by an authorized individual, such as an officer of the corporation, partner, or owner.
14. Review the completed application to ensure all fields are filled out correctly. Save your changes, and then proceed to download or print the application for submission.
15. Submit the completed application along with a check or money order to the Suffolk County Department of Health Services by the specified deadline.

Ensure timely compliance by completing your NY Food Establishment Permit Application online today.