Online Form - Temporary Food Establishment Permit

Temporary Food Establishment Permit

Asterisks (*) indicate required fields

Completion of a permit application is one step in the process of obtaining a temporary food service permit.
Please call the Health District Office at (409) 938-2411 for additional information

Who needs a Temporary Food Establishment Permit

Today's Date *

IRS Tax Exempt Number (If applicable)

Special Event *

Sponsor *

Date(s) of Event *

Time of Operation: From *

To *

Location of Event (Street Address) *

Organization *

Responsible Person *

Address *

City *

State *

Zip *

Phone *

Email *

Do you operate food establishments at other locations? *

Yes

If yes, provide names and addresses

Food items to be served	Source / Vendor	Place of Preparation	Transporting / Cold Holding Facilities	Cooking Equipment	Hot Holding Facilities

Special Conditions

A Copy of the menu (Acceptable file formats: pdf, gif, jpeg, jpg, png, bmp)

Food Handler Certificate (Acceptable file formats: pdf, gif, jpeg, jpg, png, bmp)