Business Application (New Business, New Owner, Renovation)

Please complete this application for all businesses (new business, new owner or renovation) except Child Day Care, Food Services, and Salons (Hair, Nail, Waxing, Other and Day Spas):

 

Fillable Business Application


Your ability to provide Bethel Health Department with enough information that accurately describes your project will help expedite the review process!

  1. Provide the address location: Include the name and address of the property owner. Include the legal name of the business (LLC,Inc.) and DBA (doing business as) name, business owner's name and address. Business owner or owner's agent must sign/date the application.
  2. Provide the name and address of the contractor for any construction/renovations.
  3. Describe the business. Provide details of operations/services provided. Include a description of any construction/renovation that will be.done and the total square footage of the business.  For pre-1978 buildings, Federal EPA law requires contractors that disturb more than 6 square feet of paint per room inside or more than 20 square feet on the exterior of a home or building be certified and follow specific work practices to prevent lead contamination. If applicable, contractor to provide copy of EPA RRP Certificate and write that he and/or she is going to follow lead safe work practices for renovation to be done for building space re-use.
  4. Provide a sketch/plans of the proposed floor plan. Label rooms/use of space  and room dimensions. Show storage/cleaning supply storage.
  5. Confirm water service to the property: private well or public water supply.
  6. Confirm sewage disposal of the property: private septic system or public sewer.
  7. Provide a written garbage/refuse storage management plan. Show location and details of the garbage/refuse storage area and/or enclosure.
  8. Provide a current, original, signed private well water analysis report, if applicable.
  9. Number of employees FT/PT days/times of operation.
  10. Provide a cleaning and disinfection plan for public areas. List cleaning products and provide product information sheets. Show cleaning supply storage area. This is applicable for businesses such as fitness centers, yoga studios, martial arts centers, dance studios, etc. Examples are available at Bethel Health Department.