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Temporary Event Permit

All temporary food vendors are required to have a permit to operate.

Please submit your application 2 weeks before the date of your event. 

Non- Profit Status *
Is your Organization a Non-Profit? (If Non-Profit, a Tax Exempt Letter is required)*
Event Address *
Event Address
Start Date of Event *
Start Date of Event
*
End Date of Event
End Date of Event
*
Does your event repeat? *
You may also list the interval it repeats. I.e. every second Friday.
Location of Food Preparation *
Applicant's Name *
Applicant's Name
Date of Birth *
Date of Birth
Applicant's Address *
Applicant's Address
Phone Number *
Phone Number
Applicant Certified by *
Please provide ServeSafe # if you selected ServeSafe above, or provide more information about other certification chosen.
Will you be picking up your permit?
Please provide date you want to pick up your permit.
Please provide date you want to pick up your permit.
*
The applicant attests to the accuracy of the information provided in this application. The applicant affirms that he/she will comply with the requirements of the Lincoln County Food Service Sanitation Regulations as established by the Ordinance dated 3/25/2013. The applicant agrees to allow the Regulatory Authority access to the establishment as specified under section 8-4 and any other information required by law. Permits issued by the Lincoln County Health Department are non-transferable.
Applicant Signature *
Applicant Signature
Date *
Date