San Juan County Public Health
San Juan County Health Department
735 S 200 W STE 2, Blanding, UT, 84511
Phone (435) 587-3838

Application for Child Care Food Service Inspection
*Completed application and fee of $30.00 must be received before an inspection will be scheduled.

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

Child Care Food Service Inspection:   $30.00   Item Subtotal:  

*Inspection is by appointment only. Please allow up to 5 (five) business days for completion of inspection.
Our Environmental Health Director will contact you to schedule an inspection. 
Type of Inspection Requested:
Signature of Applicant

Payment Information:
Processing Fee Rates:
Cards:2.5% ($1.50 min)
(1.5% surcharge for foreign cards)
Method of Payment:
 Update Name from Personal/Organizational Information
Name on Account:
Routing Number:
Account Number:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
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