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HD Event Organizer Application

Organizer Name:(Required)
Address:(Required)
Will the organizer by supplying water to the food booths?:
If yes, what is the water source?
Will the organize by supplying electricity to the food booths?(Required)
Type of facilites.
Will hand washing facilities be provided adjacent to the toilets?(Required)

STATEMENT: I hereby certify that the above information is correct and I fully understand that any deviation from the above without permission from Swain County Environmental Health may nullify the final approval and prevent the issuance of permits to participating vendors. I understand that a pre-opening inspection of each food vendor is required if the food vendor is not in compliance with 15A NCAC 18A. 2635 and a temporary food establishment permit will not be issued. I understand that if this application is incomplete it will be returned; if I do not correct and return to SCHD at least 15 calendar days prior to the event my application will not be considered.
Print Name:(Required)
MM slash DD slash YYYY

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