Due to the COVID-19 public health emergency, in-person submissions are by appointment only. A convenience fee per transaction will apply. License No Mo/Yr of Exp Date Issued . A permit may be suspended or revoked by the Department of Public Health for cause. Revised 10/2013. If you would like to continue helping us improve Mass.gov, join our user panel to test new features for the site. Applications, Fees and Forms. Please

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LEGAL OWNER OF BUSINESS: (Owner or Company Applying for Permit) Company Name Partnership Sole Proprietorship Driver’s License #_ STREET ADDRESS: CITY: PROVINCE: POSTAL CODE: TELEPHONE: ( ) CELL: ( ) EMAIL: ON SITE CONTACT PERSON: FOOD HANDLER CERTIFICATE: YES … Note: You must apply for a new Mobile Food Vending License in person. This mission is achieved, in part, through the issuance of certificates, licenses, permits, and registrations. Note: Mobile food vending licenses and permits can only be renewed in person or by mail. Control Fill Spreadsheet (Excel) - Save the file to your desktop before using. Health Permit Fee: A list of annual permit fees, application fees, and prorated permit fees is attached. All NYC Health Department permits and licenses that expired after March 13, 2020, (or in the case of seasonal mobile food vending permits and licenses, on October 31, 2019) remain valid because of the COVID-19 public health emergency.

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Stay Connected With EHS / Manténgase conectado con EHS, Copyright © 2017 San Bernardino County - Department of Public Health. If you are renewing in person, the document must be submitted with your renewal application. To pay for your Public Health Permit and/or License using your Credit Card (Visa, MasterCard, American Express, or Discover), Debit Card, or Electronic Check (ECheck), please visit our Payment Portal. If you do not have access to your renewal notice, complete a PIN request to have your PIN emailed to you. This page, Food Protection Program application forms, is, Food Protection Program application forms, in the scale of 1, Strongly Disagree, to 5, Strongly Agree, Professional Training & Career Development, Apply for a permit to sell or distribute bottled water or carbonated nonalcoholic beverages in Massachusetts, Apply for a license to transport frozen desserts and/or ice cream mix into the Massachusetts for the purpose of sale, Apply for a license to use dogs or cats in research and education, Apply for a certificate of Health and Free Sale/Export Statements, Apply for a license to transport bakery products into the Massachusetts for the purpose of sale, Apply for a license to process meat and poultry, Apply for a license to process poultry within scope of Mobile Poultry Processing Unit (MPPU) pilot, Apply for a license to manufacture and sell stuffed toys, bedding, upholstered furniture, and related products, Apply for a license to engage in the sterilization or sanitation of bedding, upholstered furniture, and filling materials, Apply for a license to manufacture, distribute, and/or sell methyl or wood alcohol, Steps for the Approval of Water Vending Machines, Apply for a license to operate a water vending machine, Apply for a license to operate a food and/or beverage vending machine. Find all licensure and permit application forms regulated by the Food Protection Program.

Your hearing date is printed on your summons. Durham, NC 27701 Forms. Note: PDF documents on this site were created using Adobe Acrobat 5.0 or later. For program specific permits and applications, please visit the program. Payment in person is by debit or credit card, or by check or money order payable to the NYC Department of Health and Mental Hygiene. Disclaimer | The annual health permit fee must Report COVID-19 and public health issues. If not paid within 30 days of the expiration date of the permit, a penalty will be imposed after 30 days.

Payment of the fees is required at the time the health permit application is submitted. Press Enter to show all options, press Tab go to next option, Communicable Disease & Maternal Child Health, Opioid, Substance Use, And Addiction Services, Breast and Cervical Cancer Prevention Program (BCCCP), What You Need to Know About Communicable Diseases, Rabies Information for Healthcare Providers, Mobile Unit - Pushcart Operating Schedule Form, COMMUNITY LINKAGES TO CARE (CLC) PEER SUPPORT PROGRAM, Basic Requirements for Food Service Establishments, New Food Service Establishment Plan Review Application, Existing Food Service Establishment Transitional Permit Plan Review Application, Renovation Plan Review Application for Food Service, Limited Food Service Establishment Plan Review Application, Mobile Food Unit / Push Cart Operator's Monthly Schedule Form, Temporary Food Establishment Vendor Application, Temporary Food Establishment Coordinator Application, Temporary Food Establishment general information FAQ, Tattoo permitting requirements information, Public Private School Service Request Form, Electrical System Safety at Public Swimming Pools, Improvement Permit / Authorization to Construct Application ( New Construction ), Authorization to Construct Application ( Repair ), Structural Alterations and Additions Application.

How much do you agree with the following statements in the scale of 1, Strongly Disagree, to 5, Strongly Agree? The convenience fee for Credit/Debit Cards is … Department of Public Health; ... Find all licensure and permit application forms regulated by the Food Protection Program. Fax the form to 409-938-2271; If you are using a smartphone or tablet, an app available at this link will allow you fill out, sign and submit a form ... Tattoo Permit Application (Word) Tattoo Permit Application (PDF) ... Durham County Department of Public Health ATTN: Environmental Health 414 East Main Street Durham, NC 27701 Prepares both daily and monthly collection reports.

By law, a food establishment must have a permit from Harris County Public Health to operate. All NYC Health Department permits and licenses that expired after March 13, 2020, (or in the case of seasonal mobile food vending permits and licenses, on October 31, 2019) remain valid because of the COVID-19 public health emergency. Ambulance Service. Follow the instructions for renewing your permit in the renewal notice you will receive in the mail or by email 90 days before your permit expires. The City provides assistance to small businesses with financial counseling and information about financing opportunities. Please enable JavaScript in your browser for a better user experience. We will gladly e-mail or fax any item that you cannot easily find. Accessibility, 385 N. Arrowhead Ave, San Bernardino CA 92415-0160 | 800.442.2283 | TDD 909.387.6359 Login, What to Expect When Transitioning to Adulthood, Confidential Morbidity Reports & Reporting Forms, San Bernardino County Reentry Collaborative, Nondiagnostic General Health Assessments (NGHA), wholesale food manufacturers and distributors, tattooing, body piercing and permanent cosmetics clinics. Depending on the requirement, when renewing online, you must upload the document before paying for your renewal. Anesthesia Permit-Restricted I Anesthesia Permit-Restricted II Anestheisa Permit-Unrestricted Dental Hygienist Dental Hygienist Local Anesthesia Dentist Expanded Function Dental Assistant Fictitious Name Registration Public Health Dental Hygiene Practitioner Restricted Faculty License. All rights reserved. Complete this form to apply for, renew, replace, covert from out of state, or reinstate a commercial learner's permit or driver's license. Would you like to provide additional feedback to help improve Mass.gov? Penalty fees are assessed on permits renewed 30 days after expiration date of the permit, or for failure to obtain new permit in case of transfer of ownership.

To obtain this permit from the Environmental Public Health Division (EPH) of Harris County Public Health, an establishment must complete the Plan Review process for their specific food service operation. Click Here, Aliso Canyon Disaster Health Research Study, Emergency Preparedness and Response Program. Do not include sensitive information, such as Social Security or bank account numbers. If you are exempt from this requirement, you must get a CE-200 form. Top-requested sites to log in to services provided by the state. Open PDF file, 321.25 KB, for Liquor ID Application … City of New York. If you do not find the application form you are looking for, please contact us via e-mail or call us at 858-505-6900. Share & Bookmark Press Enter to show all options, press Tab go to next option. If you are renewing online for the first time, and you did not apply for your original permit online, you will need the personal identification number (PIN) found on your renewal notice to link your permit record to your online account. Customers are encouraged to submit new applications and renewals online. If questions arise concerning the accuracy of the information, please refer to the English edition of the website, which is the official version. This license requires that you register for the certification class and apply for the license at the same time. A permit is granted on the condition that the person in the permit will comply with the laws, ordinances, and regulations that are now or may hereafter be in force by the United States Government, the State of California, and the County of San Bernardino pertaining to the business. If you are renewing in person or by mail, the document must be submitted with your renewal application. Call the Customer Call Center: Adobe Reader You can find instructions for applying for a new permit online by clicking on the links to the left and finding the permit or license for which you would like to apply. We will use this information to improve the site. The Department of Environmental Health provides the following forms and applications as a reference and service to its customers. Foster Care Application (1.5MB) Licensing Unit Staffing Pattern (79KB) Services Intake Form (286KB) Dental Section : Dental Behavioral Management Procedures Consent Form (502KB) Child Health History and Dental Authorization Form (486KB) kernpublichealth.com/wp-content/uploads/2018/07/Food-EH-Health-Permit-Application-Form_7.5.18.pdf, Mozilla/5.0 (Windows NT 10.0; Win64; x64) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/84.0.4147.89 Safari/537.36. ATTN: Environmental Health Depending on the requirement, when renewing online, you must upload the document before paying for your renewal. To download a paper application, click on the link below: If you receive a summons from the Health Department, you have the opportunity to contest the violations at the OATH Hearings Division.