Food Establishment License Application Form - Denville Division Of Health
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1
2FOOD
DENVILLE DIVISION OF HEALTH
ESTABLISHMENT
1 St. Mary’s Place
LICENSE
Denville, NJ 07834
APPLICATION
(973) 625‐8300, Ext. 261
_____________________________________________________________________________________________
Please fill out both sides of the application completely. Incomplete and illegible applications will be returned to the
sender and may result in processing delays.
Establishment Name: _______________________________________________________________________
Physical Street Address: _____________________________________________________________________
City: __________________________________ State: _____________ Zip: _________________
Phone #: ________________________ Owner’s Name: __________________________________________
Manager’s Name: ________________________________ Emergency Phone #: ______________________
Email Address: _________________________________ Fax #: __________________________________
Food Manager Certification (Name of Individual & Course Date): ___________________________________
Hours of Operation: ____________________________ # of Grease Traps (if zero please indicate):_______
Mailing Address (#/Street): _______________________________ City: _____________________________
State: _______________________ Zip: _______________ Square Footage: _______________________
Corporation, LLC or Partnership Name: _________________________________________________________
(Alternate Address or Emergency Contact/Fill in Address Below)
Street Address: ______________________________________ City: _______________________________
State: ___________________ Zip: _______________ Corporate Phone: _____________________
Water Supply (Circle One): Public Well Sewer System (Circle One): Public Septic
Mobile Vendor’s only: License Plate # & State: _______________________ _______________
Commissary Name: ________________________________________________________________________
Commissary Address: _______________________________________________________________________
(TURN OVER)
FOR HEALTH DEPARTMENT USE ONLY
Approved By: _____________________________________________ Date Approved: _______________________
License #: ______________________ Date Issued: ____________________________________
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