Suffolk County Event Permit Form PDF Details

Are you planning an event in Suffolk County and need a permit to do so? The process of obtaining an event permit can be overwhelming and intimidating, but it doesn't have to be! In this blog post, we will break down all the information necessary for securing your event permit from Suffolk County. We'll detail the requirements necessary, as well as provide tips on easily navigating the application process. Whether it's a wedding celebration or a large scale festival that you're planning, everything you need to know about filling out the Suffolk County Event Permit form is right here!

QuestionAnswer
Form NameSuffolk County Event Permit Form
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namesbackflow, suffolk permit temporary, suffolk county board of health event organizers permit, suffolk event temporary

Form Preview Example

 

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# _____

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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

PM

PM

PM

PM

PM

PM

PM

 

Closing Time

AM

AM

AM

AM

AM

AM

AM

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

No

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

Print

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.

Step number 2 in filling in backflow

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.

Step no. 3 for filling out backflow

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!

Completing segment 4 in backflow

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