San Juan County Health Department
735 S 200 W STE 2, Blanding, UT, 84511
Phone (435) 587-3838
Application For Temporary Event Food Booth Permit
Type of Operation: Single Event (Good for any ONE event not to exceed 3 consecutive days)
Food Booth Owner
Type of Business
Booth Contact Person
Requested Permit Dates
Time of Operation
Hours of operation
Will all food be prepared at the service location?
If No, give the name and address of the
approved commercial kitchen
where food will be prepared:
Name of Kitchen
Address if kitchen
List ALL prepared food menu items to be served (including prepared drinks, desserts, salads, etc.)
ADDITIONAL MENU ITEMS REQUIRE HEALTH DEPARTMENT APPROVAL!
How will food be kept COLD?
How will food be kept HOT?
Cooked to order
Chafing dish/crock pot/roaster
How will cleaning cloths be sanitized?
Bleach water solutioin (use test strips)
How will hand washing facilities be provided? Describe the setup:
How will waste water be collected?
How will waste water be disposed of? (Do NOT dump waste water on the ground or in the storm sewers!)
How will garbage/trash be disposed? Is it provided by the event?
Signature of Applicant
The Health Department Inspector will contact you shortly in response to your application. However, if you have any questions please call Ronnie Nieves at 435-359-0038. Thank you!
Temporary Food Service Permit Fee:
Processing Fee Rates:
2.5% ($1.50 min)
(4% for foreign cards)
Method of Payment:
Update Name from Personal/Organizational Information
Name on Account:
Name on Card:
Billing Street Address:
Billing ZIP/Postal Code:
Change Payment Method
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