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 Temporary Event Food Booth Permit
Type of Operation: Single Event (Good for any ONE event not to exceed 3 consecutive days)


Food Booth Owner
Organization Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone:
Email:
Type of Business

Event Information

Event Name
Location
Event Host
Phone Number
Booth Contact Person
Phone

Requested Permit Dates
First Date
Last Date
Time of Operation
Hours of operation
 


Food Preparation

Will all food be prepared at the service location?
Yes
No
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.)

Menu Items

ADDITIONAL MENU ITEMS REQUIRE HEALTH DEPARTMENT APPROVAL!

How will food be kept COLD?
Ice chests
Onsite refrigerator
Onsite freezer
Other
How will food be kept HOT?
Cooked to order
Chafing dish/crock pot/roaster
Other


Food Safety

How will cleaning cloths be sanitized?
Sanitizing wipes
Bleach water solutioin (use test strips)
Other
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
Title
Date
The Health Department Inspector will contact you shortly in response to your application. However, if you have any questions please call Dennis Shumway at 435-587-3838. Thank you!
Temporary Food Service Permit Fee:   $20.00   Item Subtotal:  
$20.00
Total:
$20.00
Payment Information:
Processing Fee Rates:
Cards:2.5% ($1.50 min)
(1.5% additional service fee for foreign cards)
eCheck:$0.75
Method of Payment:
  Credit/Debit Card
  eCheck
 Update Name from Above
Organization Name: is required
Address: is required
City: is required
State/Province: is required
ZIP/Postal Code: is required
Phone: is required
Email: is required
Type of Business is required
Event Name is required
Location is required
Event Host is required
Phone Number is required
Booth Contact Person is required
Phone is required
First Date is required
Last Date is required
Hours of operation is required
Menu Items is required
How will hand washing facilities be provided? Describe the setup: is required
How will waste water be collected? is required
How will waste water be disposed of? (Do NOT dump waste water on the ground or in the storm sewers!) is required
How will garbage/trash be disposed? Is it provided by the event? is required
Signature of Applicant is required
Title is required
Date is required
You must enter a payment method.