Tooele Health Department
             
Tooele County Health Department
151 N. Main Street, Suite 140 - Tooele, UT 84074
Phone (435) 277-2440 Fax (435)277-2444

Application for Resident Care Facility Inspection
*Completed application and fee of $50.00 must be received before an inspection will be scheduled.


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Applicant's Information
First Name: Last Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone:
Email:

 
Child Care Food Service Inspection:   $50.00   Item Subtotal:  
$50.00
Total:
$50.00

*Inspection is by appointment only. Please allow up to 5 (five) business days for completion of inspection.
Signature of Applicant
Date

Payment Information:
Method of Payment:
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Name on Account:
Routing Number:
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Institution:
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Expiration Date:
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