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18030 Foundation Drive, Suite A Noblesville, IN 46060 Phone: (317) 776-8500 Fax: (317) 776-8506 April 2025 Charles Harris, MD-Health Officer ANNUAL TEMPORARY FOOD ESTABLISHMENT PERMIT APPLICATION *PERMIT FEE MUST BE PAID PRIOR TO EVENT AS PERMITS WILL NOT BE ISSUED ON-SITE* Retail Food Establishment Name: Menu Items: Prepared at event: ☐ YES ☐ NO **Prepared prior to event: ☐ YES ☐ NO **Location: **Per Hamilton County Ordinance 16-20-7, each location utilized for food handling and preparation is required to be separately permitted per each business establishment and inspected within Hamilton County. Proof of permit and inspection must be provided if product is prepared prior to the event in another county. A copy of the Certified Food Manager Certification is required unless exempt. Additional information is available by contacting the Health Department. Person in Charge: Person in Charge Phone Person in Charge Email: Certified Food Manager: Retail Food Establishment Owner/ Co.: Address of Owner/ Co.: Owner’s Phone Owner’s Location & dates of known events: The permit fee must be paid at the Health Department two weeks prior to the facility opening for business. An Annual Temporary Permit covers all temporary events throughout the calendar year in Hamilton County Health Departments jurisdiction. Return this completed application along with a check or money order made payable to the Hamilton County Health Department. Annual Temporary Permit Fee $125.00 The undersigned applies for a license to operate a temporary food service establishment pursuant to retail food establishment sanitation requirements in 410 IAC 7-26. The undersigned certifies receipt of the guidelines for operation, and that the establishment will be operated and maintained in accordance with these conditions. Owner or Operator’s Signature Date: Permit # SIGN