Chemung County, NY · Chemung County
Food Service Establishment Permit Application
Food service operators submit this application to Chemung County Health Department to request a permit for a food service establishment.
At a glance
- Issued by
- City of Chemung County · Chemung County, Chemung County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- chemungcountyny.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
Use this application to request a permit to operate a restaurant, catering business, mobile food unit, vending operation, or other listed food service establishment in Chemung County. The form says to return the completed application and fees at least 21 days before the first day of operation. It asks for facility and operator details, insurance or exemption documentation, and other information based on establishment type.
Who needs it
Operators of food service establishments in Chemung County, including seasonal, mobile, vending, and catering operations, use this application to request a permit.
How to submit it
Return the completed application and fees to the Chemung County Health Department, Environmental Health Services, 103 Washington Street, Post Office Box 588, Elmira, New York 14902. The form says to submit it at least 21 days before the first day of operation.
About notarization
This application is signed and dated by the operator without a notary; the form also requires a signed CE-200 exemption form when applicable.
How to submit this form
- 1
Download the Application
Download the Food Service Establishment Permit Application PDF.
- 2
Complete the Applicable Sections
Provide the required facility and operator information, complete the sections that apply to your operation, and sign and date the application.
- 3
Gather Required Attachments
Attach proof of required insurance or a signed CE-200 exemption form, along with any other documents required for your operation type.
- 4
Submit to the County
Return the application and fees to the Chemung County Health Department address on the form at least 21 days before operation begins.
Frequently asked questions
- Do I need a notary for the Food Service Establishment Permit Application?
- No. The operator signs and dates the application without a notary. If applicable, the CE-200 exemption form must also be completed and signed.
- How do I submit the Food Service Establishment Permit Application?
- Return the completed application and fees to Environmental Health Services at the Chemung County Health Department address printed on the form, at least 21 days before the first day of operation.
- What attachments are required with this application?
- Submit proof of workers’ compensation and disability insurance, or a completed CE-200 exemption form. Depending on the operation, the form also calls for items such as vending locations or an outside-county commissary’s inspection report and permit.
- What information does the application request?
- It requests establishment, operator, owner, and facility details, plus information about operation type, insurance or exemption, and other sections that apply to seasonal, mobile, vending, catering, or corporate operations.