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Introduction & Checklist

The intent of this application is to provide information in addition to the plans regarding the operational procedures of the facility.
The Governing the Sanitation of Food Service Establishments (15A NCAC 18A .2600) require that plans be submitted for approval prior to construction. Plans must be submitted with the necessary paperwork (see following checklist) to the Richmond County Health Department.
This Limited Food Service Establishment (LFSE) permit application must be submitted no later than 30 days prior to construction or commencing operation. All LFSE permits shall expire on December 31st of each year.
Submittal Checklist
1. Provide a complete set of plans drawn to scale showing the placement of storage areas, food service areas, and equipment.
2. Submit completed copy of this LFSE Plan Review Application.
Establishment Plans
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Statement From Applicant*
I certify the information in this application is complete and accurate. I understand the RCHD (Richmond County Health Department) does not provide verbal approval of plans or for deviation from approved plans, and that any deviation from the plans and procedures in this application without prior written permission from the RCHD may nullify final approval and result in my not obtaining a permit, or having the permit suspended or revoked after it is issued.
1. I understand.
Electronic Signature Agreement*
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature*
Date*
Date
Requirements for Limited Food Service Establishments
North Carolina Department of Health and Human Services - Requirements for Limited Food Service Establishments
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