Food Establishment License Application Form - Denville Division Of Health Page 2
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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
___________________________________________________________________________________________
Type of Food Establishment:
Risk Type 1
$100
Risk Type 2
$200
Risk Type 3
$300
Risk Type 4
$300
Risk Type 3/4
$400
Over 10,000 sq. ft. $150 surcharge
Mobile Food
$150
Vending Machine $20 per machine (non‐potentially hazardous) $50 per machine (potentially hazardous)
Number of vending machines: ___________ Location of machines (attach additional sheets if necessary):
_________________________________________________________________________________________
_________________________________________________________________________________________
The applicant hereby agrees to operate the food establishment described above in compliance with all applicable
State and local laws and regulations.
Signature: ___________________________________________________________________________________
Print Name: __________________________________________________________________________________
Title: _________________________________________ Date: _______________________________________
INSTRUCTIONS:
All food establishments must submit a valid copy of their food protection manager certificate with their license
application (e.g. ServSafe). Mobile Food Vendors must include a copy of the Satisfactory posting from their
commissary.
Make all checks payable to the Denville Division of Health. Submit the completed license application, the required
license fee and a copy of the food protection manager certification and commissary placard (mobile vendors) to:
Denville Division of Health
1 St. Mary’s Place
Denville, NJ 07834
st
All renewals are due by December 31
of the prior licensing year to avoid legal action. If you have any questions,
contact the Denville Division of Health at (973)‐625‐8300, extension 261 between 8 AM and 4 PM Monday through
Friday.
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