Food Establishment Permit Application

Food Establishment Permit Application

Apply for a food establishment permit with the Marion County Health Department. Please complete all sections accurately.
Applicant Information
Establishment Name

Street Address Line 2
CityState / ProvincePostal / Zip Code
Establishment Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Anticipated opening date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate

Days and Hours of Operation

Owner Information

****LLC and Corporations still need to list a personal contact name and phone number****
Name

Name/Title

Mailing/Billing Address
CityState / ProvincePostal / Zip Code
Email Address
Phone
Please enter a valid phone number.Format: (000) 000-0000.
Application Checklist
Application Checklist
New establishments or those remodeling PRIOR TO OPENING MUST SUBMIT
New establishment or those remodeling PRIOR TO OPENING MUT SUBMIT
Change of ownership do not need to submit detailed plans, menu items, or plan review fee if there are no changes.
Fees and Payment

Please submit the initial permit fee Cash, MO Check, or Credit Card to Marion County Health Department 3105 Palmyra Road PO Box 1378 Hannibal, MO 573-221-1166. It is your responsibility to contact the Marion County Health Department during the construction to schedule periodic inspections. If the construction plans are altered, contact the health department to review the changes. Any changes without prior authorization may delay permit approval.
***ANY FOOD PREPARED PRIOR TO HEALTH DEPARTMENT APPROVAL WILL BE DISCARDED***
Applicant Signature
Date Signed

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Should be Empty: