Health Permit Application

CITY OF READING, PENNSYLVANIA

COAT OF ARMS - WHITE CIRCLE

 

PROPERTY MAINTENANCE DIVISION

HEALTH OFFICE

815 WASHINGTON STREET

ROOM 1-30

READING, PA 19601-3690

(610)655-6214

 

HEALTH PERMIT APPLICATION
HEALTH PERMIT # _________________ DATE ISSUED ________________
(Official Use Only)

 

REQUIRED INFORMATION / DOCUMENTATION

Copy of business owner’s ID ☐    Previous Health Permit Paid☐     Certificate of business liability insurance☐  
Valid PA ServSafe Certificate☐   (except tax exempt or non-profit)

 

GENERAL INFORMATION

Location of Business__________________________________________________

Name of Business____________________________________________________

Business Telephone__________________________________________________

Name of Business Owner______________________________________________

Address of Business Owner_____________________________________________

Business Owner Email ________________________________________________

 

TYPE OF BUSINESS/ FOOD SERVICE INFORMATION

____ Small Restaurant (less than 50 seats) _____ Large Restaurant _____ Deli _____ Bakery ____ Other
____ Small Grocery (less than 1,500 sq ft) _____ Large Grocery (1,500-2,500 sq ft) ____ Supermarket (2,500+ sq ft)

 

FOOD SERVICE INFORMATION_____ Number inside seating _____ Number outside seating

 

TYPE OF MERCHANDISE SOLD

(Check all that apply) Supplier

 

_____ Prepared or Cooked food ____________________________________

_____ Hot or Cold drink___________________________________________

_____ Grocery items_______________________________________________

_____ Fresh fruit and/or vegetables_______________________________

_____ Packaged food________________________________________________

_____ Frozen products______________________________________________

_____ General Merchandise _________________________________________

_____ Alcohol______________________________________________________

 

Name of Trash Hauler ______________________      Type of Trash Container ______________________

 

Other Permits Needed: _____ Zoning (Rm 1-27)_____ Business Privilege (Rm 1-27)

Inspections Needed: ___ Building___ Plumbing ___ Electrical ___ Mechanical___ Fire

 

 

I hereby verify that the information provided on this application is true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa.C.S.A. §4904, relating to unsworn falsification to authorities. I hereby swear and affirm to abide by and adhere to the Codified Ordinances of the City of Reading and any and all applicable Federal or State laws, statutes or regulations.

 

_____________________________________________ ____________________

Signature of Business Owner Date Submitted

FAX:(610)655-6525