Merced County, CA · Merced County
Health Permit Application and Data Intake Form
This form lets business owners or authorized representatives apply for a Merced County health operating permit, report an ownership change, or update contact information.
At a glance
- Issued by
- City of Merced County · Merced County, Merced County, California
- Notarization
- Not required: file this form without a notary.
- Official source
- countyofmerced.com
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
Use this application to request a new health permit, report a change of owner, or update contact information for a business regulated by the county’s Environmental Health Division. It asks for owner and business details, applicable program categories, and required supporting forms for certain categories. The applicant also attests that the information is accurate and signs and dates the form.
Who needs it
Business owners or authorized representatives applying for a health permit, reporting a change of owner, or updating contact information need this form.
How to submit it
Submit it to the county department named on the form; check the county website for current contact details.
About notarization
This document is signed without a notary; the applicant signs and dates an attestation under penalty of perjury.
How to submit this form
- 1
Download the Application
Download the Health Permit Application and Data Intake Form.
- 2
Complete the Form
Select the application type and enter the owner, business, contact, and program-category information requested.
- 3
Gather Required Attachments
Include any applicable program forms and use Anexos A or B when the form indicates they are needed.
- 4
Sign and Date
Sign and date the applicant attestation and complete any applicable additional owner information.
- 5
Submit to the County
Submit the completed form to the county department named on the form; check the county website for current contact details.
Frequently asked questions
- What is the Health Permit Application and Data Intake Form for?
- It is used to apply for a new health permit, report a change of owner, or update contact information for a business covered by the county’s Environmental Health Division.
- What information does the application ask for?
- It requests owner and business contact details, the business location, applicable program categories, and information about required supporting forms.
- Do I need a notary for the Health Permit Application?
- No. The document has no notary block; the applicant signs and dates an attestation under penalty of perjury.
- How do I submit the Health Permit Application?
- Submit it to the county department named on the form; check the county website for current contact details.