Number of toilet facilities that will be provided based on local building
Electrical supply provided to Vendors
Type of electrical supply provided
☐ Power Hook Up
☐ No Power Provided
Trash removal provided for food vendors?
Frequency of trash removal
Liquid waste removal provided for food vendors?
(Liquid waste = grease or waste water)
Describe how liquid waste will be disposed of. Enter N/A if no liquid waste.
Frequency of liquid waste removal:
Items to be supplied to Inspector prior to the Event: (attach to this application)
A complete list of food/drink vendors with contact information- phone numbers and e-mail.
A site plan layout which include:
• Vendor locations
• Water supply locations
• Electrical supply locations
• Restrooms and hand washing set ups (for restrooms)
• Refuse disposal location
• Waste water disposal location
• Refrigerated trailer location (if provided by the event)
Location of shared ware washing (if provided by the event)
Will the Event be providing any food or beverages (Including alcohol)?
☐ Yes (an additional Temporary Food License may be required)
The license fee for an Event is $50.00 which shall be submitted to the Regulatory Authority at
least 60 days in advance of the event.
An “event” for purposes of application this does not include a function with 10 or fewer temporary food
establishments, a fair as defined in Iowa Code section 174.1, or a farmers market.
Submit payment to:
Scott County Health Department
600 W 4th Street
Davenport, IA 52801
Phone Number: (563) 326-8618
I verify all of the information contained in the application is accurate.
Printed name of Signatory
Ck Date ________________
Amount Recd. _______________
Ck Name _____________________
Penalty Amt. __________________
Amount Due ___________________
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