Temporary Food Facility Application - Baltimore City Health Department
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1
2
3BALTIMORE CITY HEALTH DEPARTMENT
BUREAU OF ENVIRONMENTAL HEALTH
ENVIRONMENTAL INSPECTION SERVICES
1001 E. Fayette Street
Baltimore, Maryland 21202
410-396-4425
APPLICATION FEE: $50.00 Make check or money order payable to: The Director of Finance.
An application with completed menu must be submitted by each booth/stand.
Once issued, the license must be posted in the corresponding booth or stand for the duration of the event.
TEMPORARY FOOD SERVICE FACILITY LICENSE APPLICATION
EVENTS COVERING 14 DAYS OR LESS (COMAR 10.15.03.02§B)
NAME OF APPLICANT:
APPLICANT ADDRESS:
TELEPHONE:
E-MAIL:
ORGANIZATION OR COMPANY NAME:
Type of Event:
Festival
Parade
Fair
Trade Show
Block Party
Carnival
Other: ________________________________________________________
EVENT NAME:
EVENT SPONSOR NAME:
PHONE:
EVENT SPONSOR’S EMAIL ADDRESS:
LOCATION NAME:
ADDRESS:
ZIP:
CONTACT PERSON AT EVENT:
TELEPHONE/CELL:
EVENT START DATE:
EVENT END DATE:
EVENT START TIME:
EVENT END TIME:
FROM: _____/_____ /20___
FROM: _____/_____ /20___
FROM: ______AM/PM
TO:______AM/PM
Have you provided the following documents with this application: (Circle)
A letter of approval from the sponsor of the event.
Y
N
A permit from Special Events (if you are the event sponsor).
Y
N
A permit from Recreation and Parks (if you are the event sponsor).
Y
N
A completed menu.
Y
N
The application fee ($50.00 check or money order drafted payable to: Director of Finance).
Y
N
SIGNATURE:
DATE
BCHD Form T-78
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