Temporary/Seasonal Food Service Permit

Temporary/Seasonal Food Service Permit

This form must be filled out at least 5 days prior to event unless otherwise agreed upon. Applicants who are not-for-profits or selling Non-Potentially Hazardous foods must fill out Permit but are FREE OF CHARGE. Potentially Hazardous Foods are Hot Dogs, Hamburgers, Pork steaks, Bratwurst, Potato Salad, Fish, etc… Non-Potentially Hazardous foods are Kettle Corn, Cakes, Cookies, Brownies, Fruit Pies, etc.… For additional questions, please call our office 573-324-2111 x113
Name of Business/Organization:*
This will be the name on the permit
Contact Person/Person In Charge of Food Safety*

First NameLast Name
Yes, there are at least 2 business days before my first eventNo, there are less than 2 business days before I want to serve
Temporary permits should be applied for at least 5 days before any event. If you are applying for a permit with 2 business days or less, there is an additional $5 charge for expediting your permit. You will need to choose the $5 late permit fee as well as your permit fee in order to get a permit in less than 2 business days. If you do not pay the additional fee you will not be issued a permit. Operating a temporary food service without a permit will result in a fine of $75/day of operation.
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Potentially Hazardous Foods are those foods that require heat or cooling to maintain safety. Examples are: meat, milk, cut fruits and vegetables, fish, cream pies, etc…

Not-Potentially Hazardous items are usually called shelf stable. Some examples are: kettle corn, cakes, cookies, brownies, pre-packaged potato chips, candy bars, etc…
Non-Profit selling only Non-Hazardous Foods (no permit fee, no permit required)**Non-Profit selling Potentially Hazardous Foods (no permit fee, no permit required)**For Profit selling only Non-Hazardous Foods (no permit fee, permit required)**For Profit selling Potentially Hazardous Foods (permit and fee required)
*If you are applying less than 2 buisness days before the event you are required to pay the late application fee of $5.*

**If you are a not-for-profit you are not required to have a permit, but if you want one and apply less than 2 business days before the event, you will be charged the $5 late permit fee.**
1-3 days4-14 daysSeasonal (May-October)
Food(s) being served*
YesNo
Please list the Event(s) and address(s) of where you plan to serve food *
Please list the anticipated days and hours of operation*
I'll pick it upEmail me
I will mail paymentI will pay online (This includes an additional service fee)
No Payment Required
If you are mailing in payment, you must make sure your payment is made before you start service. Prices for paying by mail or with cash/check at the Health Department are as follows:

1-3 Days $10

4-14 Days $25

Seasonal (May-October) $50

Permits applied for less than 2 business days before event +$5 for all permit types.

*You MUST have a permit BEFORE you start service, even if you apply less than 2 days before the event. Any one operating a temporary food service without a permit who is required to have one will be fined $75 per day of operation.*

Send payments to or pay in person at:

Pike County Health Department

1 Healthcare Pl.

Bowling Green, MO 63334

My Products

Selling Non-Hazardous Foods-

$ Free Quantity

1-3 Consecutive Days - $10.00 by mail / $10.60 online

$10.60 Quantity

4-14 Consecutive Days - $25.00 by mail / $27.50 online

$27.50 Quantity

Seasonal (May-Oct.) - $50.00 by mail / $55.00 online

$55.00 Quantity

Permit applied for less than 2 business days before event

$5.45 Quantity

Total

$0.00

Credit Card

Should be Empty: