2026 Food Permit Application

2026 Food Permit Application

DEADLINE DATE: JANUARY 1, 2026
1831 S. Main Street Eureka, Illinois 61530 Phone: 309/467-3064 Fax: 309/467-5104 health.woodfordcountyil.gov

APPLICATION FOR OPERATIONAL FOOD PERMIT - 2026 ALL AREAS OF THIS APPLICATION MUST BE FILLED OUT COMPLETELY TO OBTAIN AN OPERATIONAL PERMIT. PERMITS WILL NOT BE ISSUED TO THOSE WHO FAIL TO COMPLY. PLEASE ATTACH ADDITIONAL SHEET(S) TO INCLUDE ADDITIONAL INFORMATION AND MENU
A-Z Listing
Establishment Lookup (Case Sensitive, type your establishment name exactly as it appears in the list above)
Establishment Name*
Establishment Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Fax Number
Please enter a valid phone number.
E-MAIL*
example@example.com (PLEASE COMPLETE SO IMPORTANT INFORMATION CAN BE SENT QUICKLY)

Facility Contact Information

Please ensure that you provide the most up-to-date information available.

OWNER: Name, address, home & cell phone numbers, and e-mail addresses, of ALL owners (include name of company, corporation, partnership, sole proprietor, association, committee, president, vice-president, secretary, treasurer, other officers, shareholders, board members, registered agents, D/B/A, LLC, LLP, INC, LTD, etc.)*

	Name	Address	Home Phone	Cell Phone	Email Address	Affiliation
Owner 1
Owner 2
Owner 3
Owner 4

Manager’s Name*
Managers Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Manager’s e-mail address*
example@example.com

Certified Food Protection Managers

	Name	ANSI Certification Number	Expiration Date
CPFM
CPFM
CPFM
CPFM

DO ALL OTHER FOOD EMPLOYEES HAVE FOOD HANDLER CERTIFICATION?*

YesNo

Additional Necessary Information
Type of water supply*

WATER WELLPUBLIC
Type of sewage disposal*

SEPTICPUBLIC
Is your facility a non-profit?*

YesNo
Registered Not for Profit Name
Tax EXEMPT Number
How are you providing a copy of your menu? If able, please provide both ways:*

ATTACHEDAVAILABLE ON WEBSITE
INCLUDE COPY OF ENTIRE MENU OFFERED - INCLUDE SPECIAL OR ANNUAL EVENTS
Menu Upload

Cancelof
Link to Menu
PERMIT WILL NOT BE ISSUED IF APPLICATION IS NOT SIGNED AND COMPLETE
By typed name (815 ILCS 333/1 et al) or signature below, the applicant affirms that all information provided on this application, or attached hereto, is true and accurate to the best of his/her/their knowledge, and that all principal owner(s) shall comply with all applicable rules, regulations, ordinances, codes, and laws governing or pertaining to the food service establishment. False or inaccurate information is cause for denial of this application and/or suspension of the permit. A representative of the Woodford County Health Department is authorized to enter/inspect any foodservice establishment in Woodford County at reasonable times and collect epidemiological samples and photograph and/or video documentation as deemed necessary. It is your responsibility to routinely check for all food recalls/alerts/notices.
Applicant’s Name*
Applicant's Signature*

Clear
Date*

MonthDayYear
Date
Typed name of Certified Food Protection Manager
I attest that this is true to the best of my knowledge
Typed name of Certified Food Protection Manager
I attest that this is true to the best of my knowledge
Typed name of Certified Food Protection Manager
I attest that this is true to the best of my knowledge
Typed name of Certified Food Protection Manager
I attest that this is true to the best of my knowledge

Payment

Please choose your method of payment
Risk Category
This is auto populated
2026 Permit Fee
This is auto populated
Late Fee ($10 per day late)
Dates Difference
Total Amount Due
Start Date

MonthDayYear
Date
End Date

MonthDayYear
Date
Date

MonthDayYear
Date
Method*

CashCheckCardNot For Profit / No Payment Needed
Are you sure? Our online card payment option is much easier.

If you are sure, our office is located at:

1831 S Main St., Eureka, IL 61530

Hours: Mon-Thurs: 7:30-4:00, Fri: 8-12

Your payment must be received prior to the January 1st deadline to avoid late fees.
Are you sure? Our online card payment option is much easier.

If you are sure, our office is located at:

1831 S Main St., Eureka, IL 61530

Hours: Mon-Thurs: 7:30-4:00, Fri: 8-12

Your payment must be postmarked prior to the January 1st deadline to avoid late fees.
Follow the link in the thank you message to make your payment for your permit.

If you pay the wrong amount, your payment will be rejected internally by staff and you will be contacted directly.

Your payment must be made prior to the January 1st deadline to avoid late fees.
Should be Empty:

2026 Food Permit Application

Operations

Facility Contact Information

Additional Necessary Information

INCLUDE COPY OF ENTIRE MENU OFFERED - INCLUDE SPECIAL OR ANNUAL EVENTS

PERMIT WILL NOT BE ISSUED IF APPLICATION IS NOT SIGNED AND COMPLETE

Type of Establishment-Application for Operational Food Permit

Payment