Coordinator's Application for a Temporary Food Event

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By providing the information below, you will assist in identifying and preventing potential public health problems that might occur during your event. A separate Temporary Food Permit application for each booth operator must be received by the Davie County Health Department, Division of Environmental Health, 10 days prior to the event along with payment of $75, payable to DCHD, for permit per vendor. You can have each vendor submit checks to you along with application and submit them to our office. For more information call (336) 751-8760.
*Note: Your payment is good for 15 days at same location.

Event Information

Event Coordinator

Provide information for the event coordinator or the responsible individual for the event.


Signature & Attachments

Attach a list of proposed food vendors with name, address, and daytime phone numbers of each operator.

Attach a map showing the layout of food booths, grounds, toilet facilities, etc.

* indicates required fields.