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Restaurant New Owner Permit Application (Transitional Permit)

  1. Restaurant New Owner Application (Transitional Permit Application)
  2. NOTICE: Once issued by the Health Department, a Transitional Permit is valid for 180 days from the date of issuance. All non-compliant items listed on this temporary permit must be brought into compliance with the NC Food Code within 180 days or the permit will be revoked.
  3. (Person, Corporation, or Partnership)

  4. (Type N/A if no seating provided for customers)

  5. Type "N/A" if no changes are going to be made to the facility.

  6. **If layout or equipment changes are planned, please provide a floor plan drawn to scale (1/4" = 1 foot) showing the placement of each piece of food service equipment, all sinks, storage areas, and trash can wash facilities. **
  7. **Provide specification sheets for each piece of new or replacement equipment. ALl new equipment must be identified on a separate list. All equipment must be NSF listed, UL classified for sanitation or be constructed to meet NSF/ANSI standards.**
  8. Proposed Hours of Operation:
  9. Type of Food Service (check all that apply)*
  10. Single Service Items (Disposable)*

    Check all that apply.

  11. Multi-use Items (reusable)*

    Check all that apply.

  12. Ex: Breakfast=10, Lunch=10, Dinner= 20. Total meals served is 40 (10+10+20=40).

  13. Type N/A if this does not apply to you.

  14. Type N/A if this does not apply to you.

  15. Type N/A if this does not apply to you.

  16. Specialized Processes

    Specialized processes require an applicaiton to the State for an approved variance.

  17. Indicate any specialized processes that will take place:*

    Check all that apply.

  18. Water Supply - Sewage Disposal - Equipment Specification
  19. Manufacturer information sheet or plate on tank.

  20. If applicable

  21. (gallons per hour)

  22. (BTU'S)

  23. (kW)

  24. Dish Machine
  25. Three Compartment Pot Wash Sink
  26. (Front to back)

  27. (inches)

  28. (inches)

  29. Can Wash/Mop Sink & Solid Waste Disposal
  30. The Can wash/Mop Sink has to be at least 36" x 36".

  31. Complete the following sections only if changes to the menu and food preparation is planned.
  32. Thawing

    Check the appropriate box(s) to indicate how food will be thawed.

  33. Refrigerator:
  34. Under Running Water:
  35. Cooked Without Thawing:
  36. Thawing in Microwave as Part of Cooking Process:
  37. Cooling

    Check the appropriate box(s) to indicate how food will be cooled rapidly from 135°F to 41°F after being cooked.

  38. In the refrigerator in shallow pans:
  39. In an Ice Bath:
  40. Using a Blast Chiller:
  41. Preparation Procedures
  42. Additional Supporting Documents If needed

    Example: equipment spec sheets, variance, HACCP plan

  43. Leave This Blank:

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