Establishment Information

Temporary Food Establishment – means a retail food establishment that operates at a fixed location for a period of time not more than 14 consecutive days in conjunction with a single event or celebration.

In accordance with local ordinance, passed by the Porter County Board of Commissioners, the temporary permit fee for Retail Food Establishments in Porter County is as follows:

Permit Fee:

**$20.00 per day with a $100.00 maximum per scheduled event if purchased more than 7 days before the event start date
**$30.00 per day with a $150.00 maximum per scheduled event if purchased 7-3 days before the event start date
**$40.00 per day with a $200.00 maximum per scheduled event if purchased 48 hours of less ahead of the event start date.

A Temporary Food Establishment Permit and receipt will be mailed to you once the application and the appropriate permit fee has been received. The Temporary Food Establishment Permit must be posted on the premises.

Event Information

Name of Event *

Location of Event *

Event Start Date * MM/DD/YYYY

Event End Date * MM/DD/YYYY

Event Hours of Operation *

Event Coordinator Name *

Coordinator Phone * 111-111-1111

Event Coordinator's Email *

Payment Amount (Based on Dates) If this is equal to 0, please check your dates to make sure they are correct.

Establishment and Owner Information

Establishment Name *

Mailing Address *

Address 2

City *

State *

Zip *

Water Source *

Municipal

Private/Well

Wastewater Disposal *

Municipal

Private/Septic

Type of Business/Ownership *

Tax ID Number

Owner(s) Name/Organization Name *

Phone * 111-111-1111

Fax 111-111-1111

Email *

Certified Food Protection Manager’s Name * Please upload a copy of the Certification below.

Certification Number * (This Certification is required for one employee. Some exemptions allow for Certified Food Handler. See Title 410 IAC 7-22-15(g) at www.in.gov.)

Certification Expiration Date *

Commissary or Base of Operation Information

Mobile unit operators, temporary food vendors and farmers market food vendors without a locally licensed retail food establishments must have a licensed commissary or base of operation from which to operate. This would include a fully equipped and licensed mobile unit. If you own an out-of-county or out-of-state food establishment, provide a copy of your Food Establishment Permit/License with this permit application. If using a licensed food establishment not owned by you, provide copies of a Commissary Agreement and the Commissary’s Food Permit/License with this Permit Application.

Complete the Commissary Information if different than Establishment Information provided above.

Name of Commissary *

Address *

Address 2

City *

State *

Zip *

Phone * 111-111-1111

Email Address 111-111-1111

Water Source *

Municipal

Private/Well

Wastewater Disposal *

Municipal

Private/Septic

Upload Required Documents *

File

Food Product Information

List all Food and Drinks to be Served/Sampled *

List all food items that will be prepared at the Commissary/Licensed Food Establishment and brought to the event. *

Before completing any online submission, please confirm that the correct form is being used and that all requested information is currently available, valid, and included with the submission as requested. If you have not worked with Porter County Health Department before, or if you have any questions or need any clarification, please call our office at (219) 465-3525 option 3 before making your submission.

Notes:
**Permit Fees are Non-Refundable and Permits are Non-Transferable.
**Operating without a permit will result in a 100% penalty fee.

Permit Application for Temporary Food Vendor

Establishment Information

Event Information

Establishment and Owner Information

Commissary or Base of Operation Information

Uploaded Files:

Facility Information

Food Product Information