Orange County, NY · Orange County
Food Service Establishment Permit Application
Food businesses use this application to request a permit from the Orange County Department of Health to operate a food service establishment.
At a glance
- Issued by
- City of Orange County · Orange County, Orange County, New York
- Notarization
- Not required: file this form without a notary.
- Official source
- orangecountyny.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This application requests a food service establishment permit from the Orange County Department of Health for a new operator, new facility, renewal, or name change. It asks for business and owner contact information, the establishment’s location and operating details, and required workers’ compensation and disability insurance documentation or an exemption. An application fee applies to commercial businesses, and applications are not accepted without payment.
Who needs it
Food service operators applying for a new permit, a permit renewal, or a permit after a change of operator, facility, or business name need this application.
How to submit it
Submit the application with payment and workers’ compensation and disability insurance documentation to the Orange County Department of Health, 124 Main Street, 3rd Floor, Goshen, NY 10924. Commercial applications are not accepted by email; non-commercial applications and supporting documents may be emailed to [email protected].
About notarization
This application is signed and dated without a notary; the signer also submits required insurance documentation or an exemption, but no sworn or notarized attachment is stated.
How to submit this form
- 1
Download the Application
Download the Food Service Establishment Permit Application PDF.
- 2
Complete the Application
Provide the operator, contact, establishment location, business type, and operating details requested on the form.
- 3
Gather Required Documents
Include workers’ compensation and disability insurance documentation or a Form CE-200 exemption, and prepare the required payment.
- 4
Submit to the County
Send the application and required materials to the Orange County Department of Health. Commercial applications are not accepted by email.
Frequently asked questions
- Do I need a notary for the Food Service Establishment Permit Application?
- No. The application has a signature and date line but no notary block. Submit the required workers’ compensation and disability insurance documentation or an exemption; no notarized attachment is stated.
- How do I submit the Food Service Establishment Permit Application?
- Submit it with payment and the required insurance documentation or exemption to the Orange County Department of Health at 124 Main Street, 3rd Floor, Goshen, NY 10924. Commercial applications are not accepted by email.
- What supporting documents are required?
- Applicants must provide workers’ compensation and disability insurance coverage documentation or a Form CE-200 exemption. Applications will not be processed and a permit will not be issued without this documentation.
- Does the application require a fee?
- The form says commercial businesses must pay an application fee and applications are not accepted without payment. It lists fees by customer seating capacity and an additional fee for frozen dessert manufacturing.