Special Event, Farmers Market And Market Permit Application Form
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21-800-563-2808
SPECIAL EVENT, FARMERS MARKET AND MARKET
PERMIT APPLICATION
Any individual or group planning to organize and/or operate a Market or Special Event (indoors or outdoors)
where persons may gather for the consumption of food and/or beverages shall notify the NORTH BAY PARRY
SOUND DISTRICT HEALTH UNIT by completing this application a minimum of 15 days prior to the event.
EVENT INFORMATION
Name of Event:
Date(s) of Event:
Time(s) of Event:
Location of Event:
CONCESSION OPERATOR INFORMATION
Name of Applicant:
Address:
Telephone:
Fax:
Number of anticipated attendees:
Type of event: Market
Special Event
Foods and ingredients purchased/supplied from:
List of food items for sale:
If sufficient space is not available to list items, please attach a separate sheet.
Additional Sheet Attached
Foods Offered:
Protection against contamination:
Running water from approved source:
Catered
Canopy
Municipal hook-up
Pre-packaged (incl. Canned)
Self-contained
Holding tank
Fresh produce (whole, uncut)
Other
Fully cooked/prepared on-site
Flooring: No
Yes
Specify: ________________________
Cooked/prepared at other site
Specify: _______________________
Address: _______________________
Hand washing facilities:
Refrigeration facilities:
Serving utensils:
No
Mechanical
Single-service disposable
Yes
Ice and cooler
Multi-use
Specify: ________________________
Other
N/A
Specify:
Cooking facilities:
Hot-holding equipment:
Canning method:
Barbecue
No
Boiling water bath
Other
Yes
Pressure canner
Specify: ________________________
N/A
Specify: ________________________
N/A
N/A
Seating area for food services:
Washroom facilities available:
No
No
Yes
Yes
Male
Female
Applicant Signature
Public Health Inspector
Date:
Date:
(yyyy/mm/dd)
(yyyy/mm/dd)
This application is:
APPROVED
NOT APPROVED
“The personal information being collected on this form is collected under the authority of the Health Protection and Promotion Act, and is
collected, used, and disclosed by the Health Unit in accordance with the provisions of the Municipal Freedom of Information and
Protection of Privacy Act and the Personal Health Information Protection Act. This information shall be used to ensure necessary health
care measures are attained. Questions covering the collection of this information may be directed to the North Bay Parry Sound District
Health Unit, 681 Commercial Street, North Bay, ON, P1B 4E7. Phone 705-474-1400 or 1-800-563-2808”
(02/11) Market and Special Event Permit Application
Page 1 of 2
NORTH BAY
681 Commercial Street, North Bay, ON P1B 4E7 • Tel: (705) 474-1400 / Fax: (705) 474-9481
PARRY SOUND
70 Joseph Street, Unit 302, Parry Sound, ON P2A 2G5 • Tel: (705) 746-5801
BURK’S FALLS
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Parent category: Business