BELL COUNTY PUBLIC HEALTH DISTRICT FOSTER HOME INSPECTION REQUEST

BELL COUNTY PUBLIC HEALTH DISTRICT FOSTER HOME INSPECTION REQUEST
FEE

$100.00
DATE PAID

MonthDayYear
FOR OFFICE USE ONLY
REC # and Payment Type
FOR OFFICE USE ONLY
INSPECTED BY
FOR OFFICE USE ONLY
APPLICANT INFORMATION

PLEASE PRINT CLEARLY
Name: Last, First
Home Address
City
State
Zip
Cell Phone
Format: (000) 000-0000.
Email
example@example.com
PLEASE SIGN
/ understand that this inspection fee is non-refundable.
Signature

Clear
Date

MonthDayYear
Date
SPECIAL REQUESTS
NOTES
Please submit the form using one of these methods. Then call during operating hours to make payment.

Walk in: Temple Office 4236 Lowes Drive, Temple, TX 76502

PHONE: 254.532.9800 ext.1111

Email: retailfood@bellcountyhealth.org

Hours of Operation:

Monday-Thursday 8am-5:00pm

Friday: 8:00am- 11:30am
Should be Empty: