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FORMS AND APPLICATIONS
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The forms in this section are provided in PDF format.  In order to view and print them, you may need to download and install  Adobe Acrobat Reader.

Business License Application   [view pdf
New businesses in Mecklenburg County must obtain a business license from the Charlotte-Mecklenburg Tax office.  Before Environmental Health staff will sign off on the business license request, you must (1) complete and submit this form, and (2) obtain the signatures of officials in Building Standards and Zoning offices on the business llicense application form.

Child Day Care Center Plan Review Application   [view pdf]
The information required on this form is to be submitted with plans for child day care centers in Mecklenburg County.  The information is needed to allow a complete review of plans for new construction or remodeling of existing facilities.

Home Day Care Application  [view pdf]
Home day care facilities in Mecklenburg County are regulated by the Health Department.  This form must be completed and submitted, with the appropriate payment, before a permit to operate a home day care facility will be issued.

Public Swimming Pool, Mandatory Report of Accident or Illness   [view pdf]
Accidents or illnesses attributed to a public swimming pool must be reported to the local health department within two (2) working days. Completing this form provides the information required by the rules.

Public Swimming Pool Operation Permit Application   [view pdf]
Public swimming pools in Mecklenburg County are regulated by the Health Department.  Renewal forms are sent to all existing pools in December of each year.  New pools, or facilities that have lost their applications can use this form to request a permit.

Public Swimming Pool  [Plan Review Application] [Technical Data Sheet
These forms are required by the Mecklenburg County Health Department in order to complete the plan review and approval process.

Pushcart/Mobile Food Unit Application   [view pdf]

Pushcarts and mobile food units require a permit prior to beginning operation.  This form is used to identify the unit operator and ensure that an approved commissary is secured from which the unit will operate.

Mobile Food Unit/Pushcart Route Update Form [view pdf]
This form is used to notify the Health Department that the route for a permitted mobile food unit or pushcart has been modified.

Residential Care Inspection Request   [view pdf]
Residential care inspections are requested by the agency holding the license.  This form is to be used for requesting inspection for new facilities and renewal of existing facilities. 

Temporary Food Service Establishment Application (Operator Application)   [view pdf]
Temporary Food Service Facilities must operate in conjunction with a public event and be located on the event grounds.  This application must be completed and reviewed before Environmental Health staff will issue a permit for operation of a  temporary foodservice facility.

Temporary Event Organizer Application  [view pdf]
Information is required from the organizer of a circus, carnival, festival, or similar public gathering where food will be sold.  This information is needed to allow Health Department staff to ensure that food service operations can be conducted while minimizing potential risk to the public.  The application should be returned to the Health Department as soon as possible, but at least 2 weeks prior to the event.

Time in Lieu of Temperature Control Document [view pdf]
Foodservice facilities may elect to use time in lieu of temperature as the control method to prevent foodborne illnesses in their facilities.  The selection of time in lieu of temperature is binding on the facility unless revoked in writing to the Health Department.  This application is required to formalize the process so there are no misunderstanding on the part of facility and Health Department staff.

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Mecklenburg County,
North Carolina
"Official Mecklenburg County Government Web Site"