Lodging Permit Application

Lodging Permit Application

Please fill out the form to apply for a lodging permit with Marion County Health Department.
Establishment Name*
Establishment Address*

Street Address

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

MonthDayYear
Date
Establishment Owner Information
Name*
example@example.com
Contact Person*
example@example.com
Billing Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email Address*
example@example.com
THE ESTABLISHMENT SHALL NOT BE OCCUPIED PRIOR TO MISSOURI DEPARTMENT OF HEALTH APPROVAL. PLEASE SUBMIT THE PERMIT FEE TO MARION COUNTY HEALTH DEPARTMENT 3105 PALMYRA ROAD HANNIBAL, MO 63401 573-221-1166. PAYMENT CAN BE MADE BY CASH, MO CHECK OR CREDIT CARD. PERMIT FEE IS 5-49 ROOMS $100.00 PLUS $1.00 PER ROOM, 50 ROOMS AND UP $200.00 PLUS $1.00 PER ROOM
Establishment Owner Information
Should be Empty:

Establishment Owner Information