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Institution Plan Review Application

  1. Institution Plan Review Application/ New Operator Application

  2. Relation to owner (mark one)
  3. Facility Information To Be Completed by Applicant

  4. Type of Facility:
  5. Construction type:
    1. Sewage Disposal
    2. Water Supply
    3. Adult Day Service Only: Meals Provided:
    4. Meal Preparation:
    5. Dining Utensil Type:
    6. Note

      A separate Food Service Application must be submitted if food is to be served within hospitals, nursing homes, assisted living, and other institutions.

    7. Both Applicant and Owner/Director must sign Application

    8. Electronic Signature Agreement
      By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
    9. If this is a new facility being constructed:

      SUBMIT THIS APPLICATION WITH PLANS TO: CRAVEN COUNTY ENVIRONMENTAL HEALTH 2818 NEUSE BLVD. NEW BERN, NC 28562.

    10. Leave This Blank:

    11. This field is not part of the form submission.