Permanent Food Permit Application

To register for a NEW permanent food permit, please complete the form in FULL, print, and mail with your payment.

FOOD ESTABLISHMENT PERMIT APPLICATION

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Steps

1. Step One This section is complete This section is incomplete
2. Step Two This section is complete This section is incomplete

Step One

LCHD Logo
Application for Food Establishment Permit
I (We) hereby apply for a permit to operated a Food Establishment in Livingston County
Establishment Name
Email Address
Establishment Address
City
State
Zip Code
Establishment Phone Number
Fax Number
Billing Address (if different from above)
Owner/Company Name:
Address
City, State, Zip Code
Phone Number
Fax Number
Email Address
Does the establishment do catering or have a delicatessen?
1. Yes
2. No
Does the establishment provide retail sale of food (grocery store, convenience mart, drug store, variety store, etc.?)
1. Yes
2. No
Please complete the Food Establishment Category Assessment on the next page and return application with appropriate fee to:
Submit Completed Form & Payment
Once completed, please send completed document and remit payment to:
Livingston County Health Department
310 E Torrance Ave
Pontiac, Illinois 61764
For Office Use Only
Permit Number
Permit Expires
Permit Sent
Continue

Step Two

Food Establishment Category Assessment
The following guidelines divide retail food establishment into three categories. The categories are not meant to imply that any given establishment is less safe than others.
Category 1
Three inspections required per year with the option to substitute one training exercise for an inspection.
1. Cooling of Potentially hazardous food (PHF)
2. Preparing and holding food for more than 12 hours
3. Extensive handling of raw ingredients and hand contact with ready-to-eat food
4. Reheating PHF which has been previously cooked and cooled.
5. Preparing Food for off-site service
6. Vacuum packaging.
7. Serving of immunocompromised individuals (majority).
Category 2
One inspection per year required.
1. Preparing food for service from raw ingredients using minimal assembly.
2. Hot or cold holding is restricted to same-day service.
3. Food requiring complex preparation is obtained from approved processing establishment.
Category 3
One inspection per year required.
1. Only prepackaged food is served.
2. PHF is commercially prepackaged.
3. Limited preparation of non-potentially hazardous food and beverages.
4. Only beverages are served.
Food Establishment Category
1. 1
2. 2
3. 3
Seating Capacity
Hours of Daily Operation:
Certified Food Manger (CFM) on duty during all hours of operation?
1. Yes
2. No
Number of Certified Food Managers
CFM Name
Certificate Number
Expiration Date
CFM Name
Certificate Number
Expiration Date
Seasonal Operation:
1. Yes
2. No
Private Water Supply:
1. Yes
2. No
Category 1
Seating Capacity: Fee:
1. >100 $235
2. 75-99 $210
3. 50-74 $180
4. 25-49 $155
5. <25 $130
6. Retail Sale of Food +$115
7. Deli/Off Site Catering +$115
Category 2
Seating Capacity: Fee:
1. >100 $210
2. 75-99 $185
3. 50-74 $155
4. 25-49 $130
5. <25 $105
6. Retail Sale of Food +$115
7. Deli +$115
Category 3
Seating Capacity: Fee:
1. >100 $210
2. 75-99 $185
3. 50-74 $155
4. 25-49 $130
5. <25 $105
6. Retail Sale of Food +#115
Total Permit Fee
Total Permit Fee
Total Permit Fee

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Contact Us

Environmental Health

Email the Environmental Health Team

Mailing Address
310 E Torrance Avenue
Pontiac, IL 61764

Phone: 815-842-5916

Fax: 815-842-4070

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