{[PNAME]}
{[CNAME]}
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[PPHONE]}
{[AWEBSITE]}
Specify the Address of the Business *
  • Business Details
  • Food Establishment
  • Food Suppliers and Cleaning
  • Food Vending Machine
  • Certification
Last Name *
Phone # *
ZIP *
City *
Address *
If "Yes," specify Seating Capacity
Block
State *
Food Court *
Business Details
Registration Type *
Phone # *
Poultry Slaughter House *
First Name *
If food or beverage is consumed on the premises (except Sidewalk Cafe):
Address 2
Property
Food Service Locations
Day Care Facilities *
If business category is Sidewalk Cafe, answer the following:
Phone # *
Name *
Pharmacies *
If "Other" specify
Nursing Homes *
Lot
Meat Establishments *
Emergency Contact Details
Operator Name
Do you have designated seating capacity?
Milk License *
Federal ID # *
Florist *
Business Category *
First Name *
Business Owner Details
Church and School Kitchens *
Address
Licenses Required
Prepackaged License *
Email *
Description *
Vending Machine License *
Festival *
Seating Capacity
If "No" provide Square Footage
Email *
Last Name *
Business
How many Women's
State Milk License #
How many Food Handlers Employed *
Do you have Public Bathrooms? *
Do you sell milk? *
Do you have the "Alcohol and Pregnancy" warning posted? *
Do you have a Certified Food Manager? *
How many Men's
Food Establishment
If yes, how many?
Do you have a Liquor License? *
Do you have a Dance Hall? *
Do you have "No Smoking" and "Exit" Signs posted? *
Food Suppliers
City, State, ZIP
Potable water supplied according to regulations and stored and handled in a sanitary manner and protected from contamination.
Separate area for loading and unloading food and/or related supplies.
Cleaning Service
List vehicle(s) type, make and model
Liquid wastes of retention tanks from mobile units connected to and discharging to a sanitary sewerage disposal system conforming with the Standards for the Construction of Individual Subsurface Sewage Disposal Systems and the N.J. Water Pollution Control Act Regulations and Local Laws, Ordinances and Regulations.
List supplier(s) name and address
Location for flushing drainage of liquid wastes.
(Drains comply with State and Local Plumbing Regulations.)
Services Provided: *
Surface area constructed of concrete or machine-laid asphalt or a smooth non-absorbent material... maintained in good repair, clean and graded to drain.
Other services provided:
Overhead protection for any supplying, cleaning or servicing operation.
Explain, type of procedure to sanitize food contact surfaces and sketch of area where this will be provided:
Separate for providing potable water servicing.
Cleaning Establishment Address
List machine(s) and locations by address and the make and description of each machine therein
Address of each commissary and other establishment where supplies for such machine(s) are kept and where such vending machines are repaired or renovated
List applicant(s) and their titles
Food Vending Machine
Type Full Name :
Sign With Hand
Granting of this License requires compliance with all the applicable Ordinances of the {[CNAME]} and the Laws of the State of New Jersey covering such establishments. It is further agreed that this License will be surrendered to the {[CNAME]} on demand for just and valid cause.
* Important: Proof of Business Liability Insurance, valid State Milk License and current Tax ID must be attached in order to process your application.
Poultry Slaughter House
Total Vehicle
Business
(Square Feet)
Day Care Facilities
Seating Capacity
Milk License
Vending Machine License
Festival
Prepackaged License
Sidewalk Cafe Seating Capacity Fee
Total Food Supplier
Total Vending Machine
Fee Schedule
Food Court
Amount Due
Pharmacies
Certification
Required Documents
Applicant Signature
Nursing Homes
Church and School Kitchens
Florist
Meat Establishment