<p> BASTROP COUNTY DEVELOPMENT SERVICES Health and Sanitation Services</p><p>TEMPORARY FOOD PERMIT APPLICATION</p><p>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.</p><p>Name of Business: ______</p><p>Business Owner Name(s): ______</p><p>Drivers License Number: ______Date of Birth: ______</p><p>Mailing Address : ______/______/______Address city zip code</p><p>Day Phone Number: ______</p><p>Fax: ______email address: ______</p><p>Name of Event: ______</p><p>Event Location: ______</p><p>Date of Event: ______</p><p>Days and Hours of Operation: ______</p><p>List type of Foods to be sold: ______</p><p>Number of Employees (including management, family, and owners): ______</p><p>Number of Employees that have Food Managers Certification: ______</p><p>Name of Employee: ______FMC expiration date: ______</p><p>Fee Schedule (Check or Money Order Only)</p><p>______$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</p><p>______Signature of Applicant Date</p>