Bastrop County Development Services

BASTROP COUNTY DEVELOPMENT SERVICES Health and Sanitation Services

TEMPORARY FOOD PERMIT APPLICATION

Return completed application and check or money order fee payable to: Bastrop County at the Department of Environmental & Sanitation Services, 806 Water Street, Bastrop, Texas 78602. For additional permitting assistance call 512/581-7176.

Name of Business: ______

Business Owner Name(s): ______

Drivers License Number: ______Date of Birth: ______

Mailing Address : ______/______/______Address city zip code

Day Phone Number: ______

Fax: ______email address: ______

Name of Event: ______

Event Location: ______

Date of Event: ______

Days and Hours of Operation: ______

List type of Foods to be sold: ______

Number of Employees (including management, family, and owners): ______

Number of Employees that have Food Managers Certification: ______

Name of Employee: ______FMC expiration date: ______

Fee Schedule (Check or Money Order Only)

______$25.00 for Temporary Food Permit (permit is valid for 3 consecutive days per event) ______Non-Profit – Include copy of 501 (C) and return with application

______Signature of Applicant Date