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  1. LCHD Logo
    Livingston County Health Department
  2. Application for Food Establishment Permit
  3. I (We) hereby apply for a permit to operated a Food Establishment in Livingston County
  4. Billing Address (if different from above)
  5. Does the establishment do catering or have a delicatessen?
  6. Does the establishment provide retail sale of food (grocery store, convenience mart, drug store, variety store, etc.?)
  7. Please complete the Food Establishment Category Assessment on the next page and return application with appropriate fee to:
  8. Submit Completed Form & Payment

    Once completed, please send completed document and remit payment to: 

    Livingston County Health Department
    310 E Torrance Ave
    Pontiac, Illinois 61764

  9. For Office Use Only
  10. Leave This Blank: