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FOOD ESTABLISHMENT PERMIT APPLICATION

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Steps

  1. 1. Step One
  2. 2. Step Two

  • Step One

    2. LCHD Logo
      Livingston County Health Department
    4. Application for Food Establishment Permit
    6. I (We) hereby apply for a permit to operated a Food Establishment in Livingston County
    22. Billing Address (if different from above)
    35. Does the establishment do catering or have a delicatessen?
    37. Does the establishment provide retail sale of food (grocery store, convenience mart, drug store, variety store, etc.?)
    39. Please complete the Food Establishment Category Assessment on the next page and return application with appropriate fee to:
    41. 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

    45. For Office Use Only