Bismarck-Burleigh Public Health
500 E Front Avenue, Bismarck, ND 58504
701-355-3400 ● Fax: 701-221-6883 ● Email: bbph@bismarcknd.gov
FOOD LICENSE APPLICATION
Business Name: Business Phone #:
Business Address:
City: State:
Zip:
Mailing Address:
City: State:
Zip:
Owner’s Name: Owner’s Phone #:
Owner’s Email: Applicant’s email:
Applicant’s Name & Title: Applicant’s Phone #:
As the Applicant/Licensee, I am (check which best applies): Projected Opening Date:
□
Starting a new business in a new structure (New business)
□
Starting a new business in an existing structure (New business)
□
Taking over an existing business (New owner) Name of existing business:
Food License Category that best describes your operation (see categories on 2
nd
page):
Total square footage (of areas used for food preparation, storage, display and customer seating):
Will your food establishment have exposed (unscreened) outer openings (i.e.: retractable doors, etc.): ☐ Yes ☐ No
Floor plans, equipment list and an anticipated menu must be submitted with this application for all new businesses:
(Note: Submission of floor plans, equipment list and anticipated menu is not required for new owners of an existing business if there will be
no remodeling, no relocating of equipment and no menu changes.)
Floor plans – must be drawn to scale and show the proposed layout, arrangement, mechanical plans, and construction materials of
work areas, and proposed fixed equipment and facilities.
Equipment list – that includes the types and models of all equipment (including sinks) that will be used for food service.
(Note: equipment and multi-use utensils shall comply with applicable National Sanitation Foundation standards or their equivalent).
Anticipated Menu – that list all foods that will be offered to the public and identifies:
o
Foods that will be served raw or undercooked for which a consumer advisory is required
o
Foods that will be made from scratch as opposed to those that are received in ready to eat form
o
Foods that will go through a cook and cool process.
o
Foods that food go through a specialized process (i.e.: smoking – as method of food preservation, curing, fermenting, reduced
oxygen packaging - aka vacuum packing, sprouting, processing and packaging juice, canning or adding components/additives
to TSC foods to render shelf stable.
Construction and/or remodeling can occur only after the applicant has been notified that their submitted plans have been approved.
Upon receiving application materials, a plan review will be conducted. Electronic copies are preferred and can be emailed to
asattler@bismarcknd.gov Plan reviews can take up to 10 days. The applicant will be notified when the plan review is completed and the
license fee
amount, which can then be paid. The applicant must schedule
a pre-operational inspection with Bismarck/Burleigh Public
Health after construction is complete, all equipment is installed and functional and the final cleaning has occurred. Upon passing
the pre-
operational inspection a food license will be issued.
With my signature, I agree to operate the above named food establishment in accordance with Bismarck’s Food Code and understand that
failing to do so can result in the suspension or revocation of the establishment’s food license. I understand that any changes to my
submitted plans and specifications must be pre-approved by Bismarck’s Environmental Health Division and that unauthorized changes
may result in the revocation of my license application.
License Holder’s Name (Print)
License Holder’s Signature: Date:
FOR OFFICE USE ONLY:
Date Recvd:
Assigned EHS:
click to sign
signature
click to edit
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