Restaurant/food Establishment Application Form printable pdf download

TOWNSHIP OF NEWTOWN

BOARD OF HEALTH

RESTAURANT/FOOD ESTABLISHMENT APPLICATION

(Chapter 86)

“Restaurant” – Restaurant, coffee shop, cafeteria, short-order café, luncheonette, tavern, sandwich stand, soda fountain, or

any other place where food or drinks are served, sold, or prepared and sold, or given away, to be consumed on the premises, as

well as kitchens or other places in which food or drink is prepared for sale elsewhere.

“Food Establishment” – any place where food or drink intended for human consumption is kept, stored, manufactured,

prepared, dressed, handled, sold, or offered for sale with or without charge, either at wholesale or retail, and not consumed on

the premises; provided, however, that the term “Food Establishment” shall not include a “public eating or drinking place.

Name of Establishment:___________________________________________________License No._________________

Physical Address: ____________________________________________________________ Phone: ________________

Name of Owner: ___________________________________________________________________________________

Mailing Address: ____________________________________________________________ Phone: _________________

Number of Employees (include full- & part-time): _________________________________________________________

Method of Trash, Garbage & Waste Disposal:

1. Trash Collector: ____________________________________________ Phone: ______________________

2. Garbage Collector: __________________________________________ Phone:______________________

3. Meat/Poultry Collector: ______________________________________ Phone:______________________

Square foot floor area: __________________________________________________________________________

(Must include total floor area of the establishment)

FLOOR AREA

PERMIT & INSPECTION FEE

Less than 1500 square feet

$101.00

1,501 – 2,500 square feet

$151.00

2,501 – 5,000 square feet

$226.00

5,001 – 7,500 square feet

$351.00

7,501 – 10,000 square feet

$501.00

10,001 – 15,000 square feet

$601.00

Greater than 15,000 square feet

$701.00

Newtown General Code §86-4B(2)

Signature of Applicant: ______________________________________ Phone: __________________________

Note: Application for renewal of a permit shall be made prior to January 1

of each year

in accordance with Code of the Township of Newtown.

Revised 2014

Restaurant/food Establishment Application Form