Type Full Name :
Sign With Hand
Certification
Phone #
Applicant Information
Name
Phone #
State
{[PNAME]}
Address
Contact Information
# of Days
Event Name
List food being served and the source of the food.
Setup Date
City
Event Information
Fewer than 7 days $100
7 through 14 days $200
1130 Knoll Road, Lake Hiawatha
{[CITY]}, {[STATE]} 07034
(973) 263-7160
{[AWEBSITE]}
License Fee
Applicant Signature
ZIP
Applicant Title
Email
Fee
Please attach the source of food (if applicable).
Phone #
Name
The information contained in this application is accurate to the best of my knowledge. I agree in the event this license is granted, to abide and comply with the applicable law, ordinances, codes and regulations of the State of New Jersey, and the Division of Health in the Township of Parsippany - Troy Hills, with full knowledge that failure to comply may result in the revocation of this license, or the imposition of such other penalties provided by law.
Name
End Date
Attachments
Event Location
Email
Start Date
Email