Phone #
Does Your Establishment Have a Grease Trap?
Establishment Name
Establishment Details
Address
Are there vending machines on the premises?
Registration Type
Mailing Address different from physical address?
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
Address 2
Email
Number of Seats
Establishment Category
Mailing Address
Description of Food Services/Products to Be Offered
{[PNAME]}
Type the Street Number and Name to Select the Address. (For Mobile Establishments, Please Select "Non Resident or Address Not Found")
  • Owner Details
  • Food Truck Details
  • Food Handler Training
  • Corporation or LLC Officer
  • Fee Schedule
  • Attachments & Certification
Address
Is Building Owner Same as Business Owner?
Address
Building Owner
Phone #
Last Name
State
Plumber Details
City, State, ZIP
First Name
Name
Last Name
First Name
Corporation (if applicable)
ZIP
Email
Address
Phone #
Emergency Contact
Retail Food Establishment Owner Details
Phone Number
Name
Phone #
City
Email
License #
Email
Food Truck Street Route
Food Truck Make
License Plate #
Food Truck Model
Food Truck Details
Food Handler Details
Please provide name(s) of person(s) who attended Food Handlers Training Course and Expiration date of certification.
Corporation or LLC Officer Details
Application Fee
Description Fee
Risk Type 1 as defined by N.J.A.C. 8:24 $50.00
Risk Type 2 as defined by N.J.A.C. 8:24 $100.00
Risk Type 3 as defined by N.J.A.C. 8:24. $150.00
Risk Type 4 as defined by N.J.A.C. 8:24 $200.00
Mobile Food Truck $100.00
Mobile Ice Cream Truck $75.00
Food/Beverage Vending Machine $10.00
Late fee (after January 31st) $25.00
**Late fee will be incurred if application OR payment is received after January 31st
Late Fee
Fee Schedule
Type Full Name :
Sign With Hand
Please attach the Food Protection Manager Certification below.
The undersigned do hereby apply for a license to operate a retail food establishment in the {[CNAME]}.

I/We agree to abide by all regulations and ordinances of the City of Linden, County of Union and the State of New Jersey.

Certification
Attachments
Applicant Signature