2. Temporary Food Event Organizer Application

   This application must be completed and submitted to the Craven County Health Department (CCHD) to provide information about all food preparation and sales to the public at any public event or exhibition within Craven County. In Addition to this organizer application, a separate Food Vendor Application must be submitted by each food service vendor participating in the event or exhibition. This application must be submitted with a map of the event site indication the location of all the food booths.

   Please Note:

   This application, map, and Food Vendor Application(s) must be submitted no later than 15 days prior to the event.

   A fee of $75 fee will be required for each food service permit and must be paid with the submission of each Food Vendor Application.

6. Event Information
8. Name of Event*
9. Date of Event (Start and End)*
   Date of Event (Start and End) Start Date

   —

   Date of Event (Start and End) End Date

   *If the event ends on the same day, enter the same date for both.

11. Address of Event*
12. City*
14. State*
15. Zip Code*
19. Organizer Information
21. Organizer Name:*
22. Organizer Phone Number:*
23. Organizer Email:*
25. Organizer Address:*

    Street, City, State, Zip Code

27. Additional Organizer Contact 1:

    Name

28. Additional Organizer 1 Phone #:
30. Additional Organizer Contact 2
31. Additional Organizer Phone #:
35. Additional Event Information
37. Number of Anticipated Food Booths*
38. Date and Time of Food Booth Set Up:*
    Date and Time of Food Booth Set Up:

    Date and Time of Food Booth Set Up:
40. Source of Water for Food Booths*
    -- Select One --Public Water Supplied by OrganizerOn-site Private Well (requires testing by CCHD)Water Supplied by Food VendorOther
41. If other, please specify:
43. Check the following items supplied for the food booths by the Organizer:*

    1. Electricity
    2. Drinking Water Hose(s)
    3. Grease Disposal
    4. Refrigeration

    1. Recycling
    2. Garbage Pick-up
    3. Toilet Facilities
    4. Waste Water Disposal
45. Will the event include a petting zoo or pony rides?*
    -- Select One --YesNo
46. If Yes, how many hand washing facilities will be available?*
48. Map of Event Site
49. Additional Documents

    Event outline/timeline

53. ** I certify that the information in this application is complete and accurate. I understand that all changes to my operation must be submitted to the Craven County Healht Department for review and approval prior to the day of the event. **
55. Organizer Signature
56. Today's Date:
    Today's Date:
Leave This Blank:


58. 1. Receive an email copy of this form.
59. Email address

    This field is not part of the form submission.

60. Submit

* indicates a required field