The application shall include:
(A) The name, mailing address, telephone number and original signature of the person and/or operator applying for the permit and the name, mailing address and location of the bed and breakfast establishment, retail food establishment and/or temporary food establishment;
(B) Information specifying whether the bed and breakfast establishment, retail food establishment and/or temporary food establishment is owned by an association, corporation, individual, partnership or other legal entity;
(C) A statement specifying whether the bed and breakfast establishment, retail food establishment and/or temporary food establishment:
(1) If not permanent, is mobile and/or temporary; and
(2) The operation includes one or more of the following:
(a) Prepares, offers for sale or serves potentially hazardous food:
1. Only to order upon a consumer's request;
2. In advance in quantities based on projected consumer demand and discards food that is not sold or served at an approved frequency;
3. Using time, rather than temperature, as the public health control as specified under 410 I.A.C. 7-24; or
4. Prepares acidified foods as defined in 410 I.A.C. 7-21-3.
(b) Prepares potentially hazardous food in advance using a food preparation method that involves two or more steps which may include combining potentially hazardous ingredients; cooking; cooling; reheating; hot or cold holding; freezing; or thawing;
(c) Prepares food as specified under division (C)(2)(b) above for delivery to and consumption at a location off the premises of the bed and breakfast establishment and/or retail food establishment where it is prepared;
(d) Prepares food as specified under division (C)(2)(b) above for service to a highly susceptible population, as defined in 410 I.A.C. 7-24;
(e) Prepares only food that is not potentially hazardous; or
(f) Does not prepare, but offers for sale only prepackaged food that is not potentially hazardous.
(D) The name, title, address and telephone number of the operator directly responsible for the bed and breakfast establishment, retail food establishment and/or temporary food establishment;
(E) The name, title, address and telephone number of the person who functions as the immediate supervisor or the person specified under division (D) above such as the zone, district or regional supervisor;
(F) The names, titles and addresses of:
(1) The persons comprising the legal ownership as specified under division (B) above including the owners and operators; and
(2) The local resident agent if one is required based on the type of legal ownership.
(G) A statement signed by the application that:
(1) Attests to the accuracy of the information provided in the application; and
(2) Affirms that the applicant will:
(a) Comply with this chapter; and
(b) Allow the County Health Department access to the bed and breakfast establishment, retail food establishment and/or temporary food establishment and records as specified in 410 I.A.C. 7-15.5 and 410 I.A.C. 7-24.
(H) Other information required by the County Health Department.
(Ord. 2004-12, passed 12-20-2004)