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
Date

Days and Hours of Operation

Rows	Open	Closed
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday

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

$100.00 PLAN REVIEW$75.00 INITIAL FOOD ESTABLISHMENT FEE OR PRIOR ESTABLISHMENT FEEDETAILED PLANSMENUA WRITTEN CLEANING SCHEDULE FOR THE ESTABLISHMENT AND EQUIPMENTA WRITTEN EMPLOYEE ILLNESS POLICYWRITTEN PROCEDURES FOR PROPER FOOD COOKING AND HOT HOLDING TEMPERTAURESWRITTEN PROCEDURES FOR PROPER FOOD COOLING AND REHEATING TEMPERATURESWRITTEN PROCEDURES FOR CLEANING AND SANITIZING OF FOOD CONTACT SURFACESWRITTEN PROCEDURES FOR DOCUMENTING REFRIGERATION TEMPERATURESWRITTEN PROCEDURES FOR FOOD DISCARD DATINGWRITTEN PROCEDURES IF TIME WITHOUT TEMPERATURE CONTROL WILL BE USED
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
Date
Should be Empty:

Food Establishment Permit Application

Applicant Information

Owner Information

Fees and Payment

***ANY FOOD PREPARED PRIOR TO HEALTH DEPARTMENT APPROVAL WILL BE DISCARDED***

ANY FOOD PREPARED PRIOR TO HEALTH DEPARTMENT APPROVAL WILL BE DISCARDED