Application for Seasonal Temporary Food Service Permit

Applicant Information

Name of Business/Group

Operator/Owner Phone #

Address

On-site Contact Person

On-site Contact Phone #

Planned Locations of Operation

Permit Type

*Apply and pay at least 7 days prior to first event.*

Permit Type

Seasonal - Low Risk (Kettle corn, snow cones, other non-TCS food) — 7 consecutive months: $150

Seasonal - High Risk (Meat or other TCS foods) — 7 consecutive months: $250

Note: A person or business can receive only one seasonal permit per 12 month period. For example, if your seasonal permit begins on May 1, 2019, it will expire on November 30, 2019, and you cannot apply for a new seasonal permit until May 1, 2020.

Certified Food Protection Manager

A Certified Food Protection Manager Certificate is required. Attach a copy of the certificate(s) below.

Certificate Holder Name

I.D. #

Certificate Expiration Date

Upload Certificate(s)

Drop files here or

Accepted file types: pdf, jpg, jpeg, png, doc, docx, Max. file size: 10 MB.

Attach a copy of the Certified Food Protection Manager Certificate(s).

Food & Beverage Service

Food/Beverages to Be Served

Where Food Will Be Purchased

Water & Wastewater

Is public water available on site?

Yes

If well water, provide most recent water test results.

Well Water Test Results (if applicable)

Accepted file types: pdf, jpg, jpeg, png, doc, docx, Max. file size: 10 MB.

Upload your most recent water test results if the site uses well water.

If No, identify the water source and method of transport to site

Describe how wastewater will be properly disposed of

Certification

I hereby certify that the above information is true and correct, and that I agree to abide by all applicable Fulton County Health Ordinances. I understand that fees are not refundable.

Applicant’s Signature

Date