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October 2025 October 2025 Charles Harris, MD-Health Officer Retail Food Establishment Permit Application Permit application and materials must be submitted to the Hamilton County Health Department at least 30 days prior to the planned opening of the business. CHECK ONE: ☐ New Facility I ☐ Change of Owner (Existing Facility) I ☐ Remodel of Existing Facility I ☐ Commissary Retail Food Establishment Name: Retail Food Establishment Address: Retail Food Establishment Business Hours: Retail Food Establishment Phone Retail Food Establishment Fax Retail Food Establishment Email: Person in Charge: Certified Food Manager: Name of Retail Food Establishment Owner/Co.: Address of Owner/Co.: City: State: Zip: Owner’s Phone Owner’s Fax Owner’s Email: The Hamilton County Health Department requires a $150.00 plan review fee to be submitted with a new facility, change of owner, or remodel application. *In addition, there may be a $100 fee for operating without a permit including continuous operation of facility under new ownership if an application is not received prior to ownership change. The plan review process will not begin until the appropriate fee(s) have been paid. Please include payment for the appropriate fee(s) along with the application, plan review materials, and all items listed in the checklist on the second page of this application. Do not include payment for the permit fee. Your inspector must give approval before the permit fee can be accepted. Once approval has been given, the permit fee must be paid at the Health Department prior to the facility opening for business. ☐ Plan review fee remitted with application: $150.00 ☐ Operating without a permit fee: $100.00 (when applicable) Signature: Date: Permit SIGN ---PAGE BREAK--- 18030 Foundation Drive, Suite A Noblesville, IN 46060 Phone: (317) 776-8500 Fax: (317) 776-8506 18030 Foundation Drive, Suite A Noblesville, IN 46060 Phone: (317) 776-8500 Fax: (317) 776-8506 Please check the correct number of employees for a Food Service Facility Example: Fast Food and Full-Service Restaurant Please account for all Full and Part-time employees. # of Employees Permit Fee Amount ☐ 1 to 9 $200.00* ☐ 10 to 20 $300.00* ☐ 21+ $400.00* Please check the correct square footage for a Retail Food Store Example: Grocery and Convenience Stores Square Footage Permit Fee Amount ☐ 1 to 1000 $200.00* ☐ 1001 to 8000 $300.00* ☐ >8000 $500.00* ☐ Bed and Breakfast $200.00* *NOTE: The permit fee for a Food Service Facility or Retail Food Store that is operating less than four consecutive months in any one calendar year will be one-half the license fee. This applies only to those facilities that start operation after September 1st of that calendar year only. * Application Submission and Review Checklist: ☐ Application ☐ Copy of Certified Food Manager Certification ☐ Copy of Employee Health Policy ☐ Copy of Vomiting and Diarrhea Cleanup Procedure ☐ Food Establishment Plan Review Packet ☐ Floor plan with all sinks, drains, and equipment located ☐ Menu (a tentative menu is okay if a final menu has not been set) ☐ $150 Plan Review Fee Permit application and materials must be submitted to the Hamilton County Health Department at least 30 days prior to the planned opening of the facility for a timely review by our staff and to allow the required inspections to be performed.