Return both the completed application and non-refundable fee to:
You may contact our office at (210) 658-4175 Fax - (210) 658-8065
“City of Choice”
Name under which business is conducted (DBA):
Physical address to be licensed:
Telephone number at address:
Level 3 - (Restaurants or Retail Establishments with on-site cooking, schools etc) Fees
A) Gross Sales of $0.00 to $99,999.99 (schools)
$195.00
B) Gross Sales of $100,000.00 or more $245.00
Level 2 - (Daycares without on-site cooking. Bars, Nightclubs etc) $150.00
Level 1 - (Mobile Vendors / Retail Establishments with pre-packaged $95.00
foods to include hot dog rotisseries.)
Temporary Permit - $55.00
Event Permit -
A) 1 - 3 vendors $45.00 per vendor
B) 4 or more vendors $35.00 per vendor
Follow Up Inspection - $65.00
Verification: I swear or affirm that all information in this application is true and correct. I further certify by
signature hereon, that I am authorized to execute this document on behalf of the corporation and am
eligible to receive a license.
Signature Printed Name
Title (EX: Owner, Partner, President, Corporation Designee / Agent)
Date
CITY OF CIBOLO - PLANNING & ENGINEERING
P.O. BOX 826 , CIBOLO, TX 78108
Environmental Health Permit Application
FEE SCHEDULE FOR INITIAL / RENEWAL / OR CHANGE OF OWNERSHIP
Fees for food service establishments are based on the gross annual volume of food sales.
Mark the appropriate volume category and remit fees accordingly.
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click to sign
signature
click to edit
PURPOSE OF THIS APPLICATION: Mark appropriate box to indicate purpose of application, and / or any changes
in status of firm.
New (Initial)
Start Date of Regulated Activity:
Renewal
Renewals are due on or before September 30th of each year
Change of Ownership
Previous Owner:
Effective Date:
Amended
Change of Location: Previous Location:
Change of Name: Previous Name:
Other:
Effective Date of Change:
Notice that Firm is out of business
Date Firm went out of business:
Normal Hours of Operation: m. to m.
(for Environmental Health Inspector's use)
Website / Internet Address:
Responsible Person in Charge at Physical Address: (name, residence address & DL number)
Name: DL #:
Address, City, State, Zip:
Billing Information: (The license and / or courtesy renewal will be sent to the following):
Billing Name:
Billing Address:
Contact Person Information:
Name of Application Preparer :
Telephone Number: Fax:
E-Mail Address:
Updated: 05/11/2018
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