BOARD OF HEALTH

Application for License

 

 

 

                                   ___________________, 200__    

 

 

I, or we, the undersigned, do hereby make application for a license to conduct an eating, drinking or food establishment located at:

 

 

 

(Address)

 

 

 


(Name of Establishment)

 

 

In making this application I, or we, agree to comply with all the ordinances of the Township of Wall and the Laws of the State of New Jersey covering such establishments.  It is further agreed that I, or we, will surrender this license, if granted, to the Department of Health on demand.

 

Signed:

 

 

 

 

 

 


Address:

 

 

 

 

 

 

 


License No.

 


Date Issued:

 


Print Name:

 

 

 

 

 

 


Home Phone:

 


Business Phone:

 

 


Inspected:

Recommendations:

 

 

 

 


(Sanitary Inspector)