"Application to Operate a Food Premise" - Prince Edward Island, Canada

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Download "Application to Operate a Food Premise" - Prince Edward Island, Canada

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**For Office Use Only**
Date Received:
Application
Last Inspected:
To Operate a Food Premise
Approved: Yes
No
Approved By:
Food Premises Name (Please Print):
Location (Where business will be conducted):
Owner’s Name (Name to go on License):
Complete Mailing Address:
Email Address:
Phone #
Fax #
PREMISE ID NUMBER (License No.)
Application Status:
Renewal :
New:
Seasonal (Date of operation):
to
Liquor License: Yes
No
Tobacco Retail Vendor License:
Yes _________
No _________
Water Supply: Municipal
Private
If you are on a private well please attach the most recent water sample result or provide sample ID #:
If sample was submitted under a name different than the business name noted above, please provide:
Type of Food Premise:
(please see reverse side)
Class 1-A ($150)
Class 1-B ($75)
Class 2 ($55)
Class 3-A ($37.50)
Class 3-B ($55)
Class 4 ($0)
If applicable, date of opening/event:
Please send application with payment to the address below at least 2 weeks prior to opening.
Signature of applicant:
Date:
.
Cheque/money order is payable to "Minister of Finance"
Please send to:
Environmental Health
PO Box 2000, 16 Fitzroy Street
Charlottetown, PE C1A 7N8
If you have any questions please contact Environmental Health at (902)368-4970
Please Note: Application Fees are non-refundable
**For Office Use Only**
Date Received:
Application
Last Inspected:
To Operate a Food Premise
Approved: Yes
No
Approved By:
Food Premises Name (Please Print):
Location (Where business will be conducted):
Owner’s Name (Name to go on License):
Complete Mailing Address:
Email Address:
Phone #
Fax #
PREMISE ID NUMBER (License No.)
Application Status:
Renewal :
New:
Seasonal (Date of operation):
to
Liquor License: Yes
No
Tobacco Retail Vendor License:
Yes _________
No _________
Water Supply: Municipal
Private
If you are on a private well please attach the most recent water sample result or provide sample ID #:
If sample was submitted under a name different than the business name noted above, please provide:
Type of Food Premise:
(please see reverse side)
Class 1-A ($150)
Class 1-B ($75)
Class 2 ($55)
Class 3-A ($37.50)
Class 3-B ($55)
Class 4 ($0)
If applicable, date of opening/event:
Please send application with payment to the address below at least 2 weeks prior to opening.
Signature of applicant:
Date:
.
Cheque/money order is payable to "Minister of Finance"
Please send to:
Environmental Health
PO Box 2000, 16 Fitzroy Street
Charlottetown, PE C1A 7N8
If you have any questions please contact Environmental Health at (902)368-4970
Please Note: Application Fees are non-refundable
Food Premises License Classification System
Class 1 – A
Fee: $150
- Food premises where:
Food is primarily consumed on the premises;
More than 25 seats are available for patrons; OR
- Food premises operating primarily as a restaurant, supermarket, or retail bakery.
Examples include licensed premises, restaurants, dining rooms, supermarkets, retail bakeries, etc.
Class 1 – B
Fee: $75
- Food Premises where:
Food is primarily consumed on the premises;
1 – 25 seats are available for patrons.
Examples include licensed premises, restaurants, cafés and other premises such as take-outs and recreational
facility canteens where food is primarily consumed on the property/premises.
Class 2
Fee: $55
- Food premises where food is primarily consumed off the premises.
Examples include take-outs or other similar food premises where food is primarily consumed off the
property/premises (no seating available) such as convenience/grocery stores, farmer’s market vendors, farmer’s
market organizers, home food production, mobile units, retail meat outlets, breweries, wineries and distilleries.
Class 3 – A
Fee: $37.50
- A food vendor who provides food service at one temporary event per year.
Class 3 – B
Fee: $55
- A food vendor who provides food service at more than one temporary event per year, OR
- The organizer of a temporary event where food service is available to the public.
This class includes event organizers and food vendors
Class 4
Fee: $0
- A community organization where:
Food is processed, prepared, packaged, handled, served or offered for sale or sold; OR;
- An institution where:
Food is served primarily for consumption by clients of that institution;
The food service is primarily non-commercial.
Examples include banquet facility/church hall, hospitals and non-profit school cafeterias and canteens
"Personal information on this form is collected under the authority of the Public Health Act, Chapter P-30.1, Section 20 (2) and
the Public Health Act Food Premises Regulations Chapter P-30.1, Section 5(1) as it relates to the operation of a food
premises. If you have any questions about the collection or use of this personal information, you may contact Environmental
Health at 902-368-4970 or toll free at 1-800-958-6400."
Please Note: Application Fees are non-refundable
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