Brick-and-Mortar Food Establishment Permit Application

  • Brick-and-Mortar Food Establishment Permit Application

  • PLEASE NOTE: Filling out this application does NOT guarantee you permission to operate. You MUST contact the Platte County Health Department in order to complete the application process. Return completed application at least 30 days prior to planned opening date.

  • Establishment Information

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Days of Operation*
  • Water Source*

  • Risk Assessment

    Answer the following questions as yes or know based on your food establishment.
  • Will the food establishment sell/serve potentially hazardous foods (PHF)/time temperature control for safety foods (TCS) that are commercially pre-packaged in an approved processing facility?*
  • Will the food establishment sell/serve non PHF/TCS that are NOT pre-packaged (pastries, snack foods, etc.)?*
  • Will the food establishment sell/serve non-pre-packaged beverages (alcoholic or non-alcoholic)?*
  • Will the food establishment reheat commercially processed PHF/TCS (hotdogs, smoked sausages, taquitos, etc.)*
  • Will the food establishment prepare foods from raw PHF/TCS ingredients?*
  • Will the food establishment be cooking PHF/TCS foods that are served immediately?*
  • Will the food establishment be cooling and reheating three (3) or less PHF/TCS food items?*
  • Will the food establishment hold PHF/TCS in hot or cold holding units after preparation or cooking?*
  • Will the food establishment be cooling and reheating four (4) or more different PHF/TCS food items?*
  • Will the food establishment prepare hot or cold PHF/TCS and hold those foods hot or cold for more than twelve (12) hours before serving?*
  • Will the food establishment prepare PHF/TCS foods in advance for next-day service?*
  • Will the food establishment be serving raw or undercooked PHF/TCS?*
  • Will the food establishment be using a specialized process including vacuum packaging and/or other forms of reduced oxygen packaging, smoking, curing or acidifying foods to extend shelf-life?*
  • Will the majority of the people served by the food establishment be highly susceptible individuals, such as the elderly, people with a compromised immune system or children under the age of 4?*

  • Required Attachments

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  • Read Before Signing

    • A properly completed application shall be submitted.
    • The application and accompanying documents shall be reviewed and approved.
    • A pre-opening inspection of the establishment with equipment in place will be conducted to determine if the facility complies with the provisions of the code.
    • Only establishments that have completed the above items shall be approved to operate as food establishments.
    • The owner(s) agree to:
      • Comply with the Platte County Missouri Government Ordinances Chapter 230: Food Service Establishments and Retail Food Establishments and Missouri Food Code.
      • Allow the regulatory authority access to the food establishment.
      • Provide records specified by the Platte County Missouri Government Ordinances Chapter 230: Food Service Establishments and Retail Food Establishments and Missouri Food Code.

    I certify that the information supplied in this application is complete and true to the best of my knowledge and I understand that any misstatement or omission of fact will render this application and any permit issued invalid.

    I am familiar with the contents of the Platte County Missouri Government Ordinances Chapter 230: Food Service Establishments and Retail Food Establishments and Missouri Food Code and understand that my food establishment permit may be suspended or revoked by the Platte County Health Department for failure to comply with the provisions of the Platte County Missouri Government Ordinances Chapter 230: Food Service Establishments and Retail Food Establishments and Missouri Food Code.

    If approved, I understand that food establishment permits may not be transferred from one person to another, from one location to another or from one type of operation to another type of operation.

     

  • This is not your annual permit fee, additional charges will apply.

  • Pre-Plan Review Fee

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      Pre-Plan Review Fee
      $50.00$50.00
        
      Total
      $0.00$0.00
      Debit or Credit Card
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