For-Profit Temporary Food Permit Application

2. LCHD Logo
   
4. Application Type

   Please Let Us Know What Type of Application You Are Applying For

   1. $35.00 Single Event Per Food Stand
   2. $55.00 If Within Two Weeks of Event
   3. $70.00 At The Time of Event Per Food Stand
   4. $110.00 Yearly Food Permit Per Food Stand
6. Name
7. Email Address
9. Address
11. City
12. State
13. Zip Code
15. Phone Number
17. Name of Food Stand
19. Event

    What Event(s) Will You Be Attending

20. Start Date
    Start Date

    Start Date
21. End Date
    End Date

    End Date
23. Location of Event
25. City
26. State
27. Zip Code
29. Menu

    Please List All Foods You Will Be Serving

33. For Office Use Only
35. Application Received
36. Permit Sent
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit Submit and Print

* indicates a required field