2. Temporary Food Service Application
   This is a temporary permit application for those who wish to serve food to the public in Ashfield. All fields with an asterisk next to them must be answered.
3. 
5. Name of Applicant/Owner
   In this section please enter the name of applicant and the name of owner if different from the applicant.
7. Applicant's First Name*
8. Last Name*
9. Middle Initial
11. Name of Business*
    Enter n/a if it is not applicable.
12. Are you the owner?*

    1. No
    2. Yes
14. Owner's First Name
15. Last Name
16. Middle Initial
20. Address
    The address below must be your resident physical address. If you have a PO Box please enter it as well in case we send out mail to you.
22. Street Name*
23. City*
25. PO Box/Address
26. State*
27. Zip*
29. Phone Number*
30. Email Address*
34. Event and Coordinator Name
    Please enter the event name where food will be served. Also enter all the required information on the event coordinator as well.
36. Event Name*
38. Coordinator Name*
39. Coordinator Phone*
41. Street Name*
43. Address2
45. City*
46. State*
47. Zip*
51. Food and Beverage List
    Please list all the foods and beverages that you will be serving at the event. Enter "none" if you have nothing to list.
53. Food Items*
54. Beverages*
56. Note: Potentially Hazardous Food Products (PHFs) require a health inspector on site. Check with us if you have any questions on this.
60. Preparation and Cooking Facilties
62. On-Site Facilities*

    If yes please describe the facilities and equipment used.

    1. No

    1. Yes
63. Describe the facilities
65. Off-Site Facilities

    If yes please indicate the location of the facilities.

    1. No

    1. Yes
66. Location of off-site facilities
68. Describe ware washing facilities for utensils and equipment? *
    If it is not applicable enter "n/a" in the field above.
70. Food Protection*
    In the box above, describe equipment and means of transporting food. Hot food is 140℉ or above. Cold food is 45℉ or below.
74. Comments
Leave This Blank:


84. 1. Receive an email copy of this form.
85. Email address

    This field is not part of the form submission.

86. Submit

* indicates a required field