On-Site Phone #
Does Your Establishment Have a Grease Trap?
Establishment Name
Establishment Details
Establishment Non-Profit?
Registration Type
{[CITY]}, {[STATE]} {[ZIP]}
Office (609) 890-3828
Fax (609)890-6093
Address 2
On-Site Email
Hours of Operation
Establishment Type
Description of Establishment
Fax #
Type the street number and name to select the Address
  • Owner Details
  • Food Handler Training
  • Plumber Information
  • Fees & Attachments
  • Certification
Is the Landlord Same as Business Owner?
Landlord Details
Phone #
City, State, ZIP
Regional Manager Name
Ownership Type
After Hours Contact Name
Corporation (if applicable)
Phone #
If Other, Please Explain
After Hours Emergency Contact Details
Phone #
Retail Food Owner Details
Phone #
Please provide name(s) of person(s) who attended a Food Protection Managers Course and date of certification.
Trainee Details
Plumber Information
First Name
Last Name
Phone #
License #
** REQUIRED DOCUMENTATION: The following must be included with the application or your license will not be issued.
  • Copy of Food Protection Manager(s) Certificates (Risk Level 3 & 4 ONLY)
  • Menu (Only if changed since last year)
  • Copy of Owner or Regional Manager's driver's license or government ID
  • Copy of Business Registry (Register your business Here)
License Fees
Risk Type 1 $175 / Year
Risk Type 2 $200 / Year
Risk Type 3 $300 / Year
Risk Type 4 Additional $75 / Year
Late Fee $100 for each 30 days the License renewal is late

First Occurrence $0
Second Occurrence
(within two years of first occurrence)
Fine: $250
Third Occurrence
(within two years of first occurrence)
Fine: $350
Fourth Occurrence
(within two years of first occurrence)
Fine: $500 and closure of the establishment for a minimum of 72 hours.
All violations shall be abated prior to re-opening.
Please attach proof of Inspection by the plumber.
Fee Schedule
(Per Township Ordinance 3021-21: Grease traps must be inspected yearly by a licensed plumber.)
Type Full Name :
Sign With Hand
The undersigned do hereby apply for a license to operate a retail food establishment and agree to comply with, and abide by, all the provisions of N.J.A.C. 8:24 of the New Jersey Sanitary Code and all local codes regulating retail food establishments. I further understand that this license is not transferrable and may be revoked upon violation of these codes. I certify that all facts and data supplied are true and correct to the best of my knowledge.
Applicant Signature