Suffolk County Event Permit Form – Fill Out and Use This PDF

The Suffolk County Event Permit form serves as a crucial document for event organizers in Suffolk County, detailing the application process for receiving a permit to host an event. This comprehensive application encompasses requirements ranging from site plans and sanitation arrangements to food vendor listings and emergency contact information. For those planning an event in Suffolk County, understanding and completing this form at least 21 days prior to the event ensures adherence to local health and safety standards.

To get started with your event planning and ensure a smooth approval process, click the button below to fill out your Suffolk County Event Permit form.

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Suffolk County Event Permit Form PDF Details

When planning an event in Suffolk County, the Temporary Event Organizer's Permit, managed by the Department of Health Services' Bureau of Public Health Protection, is a pivotal document ensuring public health and safety standards are met. With a detailed checklist that covers every aspect of event planning from sewage disposal, water, and electric line layouts to food vendor locations and toilet facilities, this comprehensive application must be submitted at least 21 days before the scheduled event to avoid a late fee. The form also mandates a detailed plan for garbage disposal, wastewater management, and final cleanup, highlighting the county's focus on environmental sustainability. The permit process is designed to accommodate events up to 14 days, emphasizing that permits cannot be renewed for successive events at the same location, thereby encouraging responsible use of public spaces. In addition to the operational logistics, the application requires a list of all food vendors and caterers, underscoring the importance of food safety. For nonprofits, the permit fee is waived with a valid tax-exempt form, showcasing the county's support for community and charity events. This meticulous application process, which also involves securing a variety of other local licenses and permits, culminates in a commitment by the event organizer to comply with the Suffolk County Sanitary Code, ensuring that they uphold public health standards and accept responsibility for any violations.

Question	Answer
Form Name	Suffolk County Event Permit Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	backflow, suffolk permit temporary, suffolk county board of health event organizers permit, suffolk event temporary

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	Page 1 of 2
	SUFFOLK COUNTY
TEMPORARY EVENT ORGANIZER’S	DEPARTMENT OF HEALTH SERVICES
APPLICATION AND PERMIT	BUREAU OF PUBLIC HEALTH PROTECTION

*SUBMIT AT LEAST 21 DAYS PRIOR TO THE EVENT


			Official Use Only	DATE RECEIVED: ________________
FEES:
__________ $	185	Permit Fee (No Permit Fee Required for Non-Profit with Copy of Tax Exempt Form Attached)
__________ $	60	* Late fee for applications submitted less than 21 days prior to the event
PERMIT ISSUED		PERMIT DENIED	SANITARIAN ______________________________________ SANITARIAN ID# _____
PERMIT ISSUED		PERMIT DENIED
				DATE ISSUED: ___________________

Applications must be accompanied by a site plan drawn to scale showing sewage disposal, water and electric lines, proposed locations of food establishments, toilets, and utility washrooms. Events cannot exceed a 14 day period. Permits cannot be renewed at the same location. Late applications may be denied at the discretion of the Department. Payment can be made by check, money order (payable to “Commissioner of Health Services”), or VISA/Master Card.

1.ORGANIZER/APPLICATION INFORMATION:


Name of Organization	Contact Person
E-mail Address	Daytime Phone #:
Mailing Address
Town	State	Zip

2.EVENT INFORMATION:

Event Name


Location:	Opening Date:	Closing Date:
Street Address	Nearest Cross Street
Town:	Average Daily Attendance:

Hours of Operation:

Day of the Week	Sunday	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday

Opening Time	AM	AM	AM	AM	AM	AM	AM
Opening Time	PM	PM	PM	PM	PM	PM	PM
	PM	PM	PM	PM	PM	PM	PM
Closing Time	AM	AM	AM	AM	AM	AM	AM
Closing Time	PM	PM	PM	PM	PM	PM	PM
	PM	PM	PM	PM	PM	PM	PM

3.Toilet Facilities for Food Handlers with Warm Running Water Hand Washing Sinks:


Number of Flush Toilets	Number of Hand Washing Sinks with warm running water
Location of Toilet Facilities		Distance from Food Vendors	FEET

4.Toilet Facilities for Public:

Number of Public Toilets Provided

Number of Hand Sinks

Number of Handicap Accessible Toilets

5.Event Set-up Information:

Source of Water Supply (If well water, attach water analysis. If public water, supply proof of source)

Will a fire hydrant be used for potable water? Yes No If yes, provide recent water sample lab analysis results and a fire

hydrant permit. A reduced pressure zone valve (with test results attached) must be connected to hydrant to prevent backflow.

Proposed Water Distribution Plan		___________________
Location of Three-compartment Sink for Utensil Washing (required for multiple day events)		___________________

Source of Hot Water Supply for Three-compartment sink

Location of On-site Mechanical Refrigeration

Source of Continuous Electric Power for the Event

Page 2 of 2


# of Trailers and Tents Used for Sleeping		# of Persons Sleeping on-site
Number of Garbage Collection Facilities	Name of Garbage Disposal Service
Name of Contracted Wastewater Pump out Service

Name, Address, and Phone # of Person Responsible for Final Cleanup of Event Site

Will the Event Feature Live Animals (i.e., petting zoos, pony rides, rodeos)? Yes

If yes, please fill out this section

Type (i.e., Petting Zoo)

Name of Company

Address

Permit #

Contact Person

Phone #

6. List of food vendors, caterers, and any other participants providing food to the public, including food for sampling and tasting.

Name

Address

Phone Number

The undersigned applicant hereby states that they are the responsible owner or manager of the said operation; that they have obtained authorization for use of the proposed location and secured licenses and permits as locally required; that they are familiar with and prepared to comply with pertinent regulations of the Suffolk County Sanitary Code, and that they accept responsibility for any and all violations of the Code caused or committed by any of their employees. Permits are not transferable.

Signature

Date

Title (Print)

BUREAU OF PUBLIC HEALTH PROTECTION 360 Yaphank Avenue, Suite 2A, Yaphank NY 11980 (631) 852-5999 FAX (631) 852-5871

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This form requires some specific information; to guarantee consistency, please be sure to pay attention to the guidelines listed below:

1. You should fill out the suffolk county board of health event organizers permit correctly, so be attentive while filling in the segments comprising these specific fields:

The best ways to fill out backflow portion 1

2. Right after performing this section, go to the next step and fill out the essential particulars in these fields - Saturday, AM PM AM PM, feet, Day of the Week, Sunday, Monday, Tuesday, Opening Time, Closing Time, AM PM AM PM, AM PM AM PM, AM PM AM PM, Wednesday AM PM AM PM, Thursday, and Friday.

3. This third segment should also be relatively simple, of Trailers and Tents Used for, Number of Garbage Collection, of Persons Sleeping onsite, Name of Garbage Disposal Service, Name of Contracted Wastewater Pump, Name Address and Phone of Person, Page of, Will the Event Feature Live, If yes please fill out this section, Type ie Petting Zoo Name of Company, Address, Permit, Contact Person, Phone, and List of food vendors caterers and - every one of these empty fields is required to be completed here.

Be extremely careful when filling out Number of Garbage Collection and Name of Garbage Disposal Service, because this is the section where many people make errors.

4. This next section requires some additional information. Ensure you complete all the necessary fields - The undersigned applicant hereby, Signature, Print, Title Print, Date, BUREAU OF PUBLIC HEALTH PROTECTION, Yaphank Avenue Suite A Yaphank NY, and FAX - to proceed further in your process!

Step 3: Before finalizing your file, you should make sure that all blanks have been filled in right. The moment you are satisfied with it, click on “Done." After registering a7-day free trial account here, it will be possible to download suffolk county board of health event organizers permit or send it via email promptly. The PDF form will also be available through your personal account page with your each and every edit. We do not sell or share any details that you type in while filling out forms at our website.

Suffolk County Event Permit Form – Fill Out and Use This PDF

Suffolk County Event Permit Form PDF Details

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