Food Premise Application Form
1. General Information
BPA# (if applicable)______________________
Application Date: ________________________
Facility Name:_______________________________________________________________________
Facility Address: _____________________________________________________________________
Applicant Name:____________________________________________________________________
Applicant’s Mailing Address:_________________________________________________________
(where approval letter will be mailed to)
Contact Numbers:___________________________________________________________________
(daytime number/ cell number for plan approval questions)
2. Premise Type (check one)
□
Public Eating Establishment (restaurant/food cart)
□
Abattoir
□
Food Distributor (grocery store)
□
Food Processor
□
Liquor Outlet (bar/ pub/ lounge)
□
Meat Processor
□ Care Home – Specify Type (group/ special/ approved/ assisted)
______________________________
3. Occupant Load – National Building Code (check one)
Type of Use of Floor Area
Area required per Person M2
Assembly use – dining, cafeteria
1.20
□
Mercantile use – food distribution
3.70
Industrial use – dairies, manufacturing/
processing
□
4.60
□
Kitchens
9.30
□
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Food Premise Application Form (continued)
4. Washrooms
a. Public Washrooms are located so that access does not require passage
through areas where food is stored or prepared
□ Yes
□ No
b. Staff washrooms do not open directly into a room where food is stored or
prepared
□ Yes
□ No
5. Kitchen/ Processing Area
Number of Plumbing Fixtures
_____ hand basins
 Is there at least one in each processing area? □ Yes □ No
_____ 2 compartment sinks
_____ 3 compartment sinks
_____ commercial dishwasher
 Are disposable wares served to the public?
□ Yes □ No
_____ floor drains
_____ grease interceptor
_____ mop/ janitor sink
6. Finishing Materials
a. General areas
 Floors __________________________________________________________
 Walls __________________________________________________________
 Ceiling ________________________________________________________
b. Washrooms
 Floors __________________________________________________________
 Walls __________________________________________________________
 Ceiling ________________________________________________________
7. Ventilation
a. Range Hood is NFPA 1996 compliant
b. Washroom ventilation supplied
□
□
Yes
Yes
□
□
No
No
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Food Premise Application Form (continued)
8. Storage ( Size and Type )
a. Dry Storage ______________________________________________________
b. Coolers __________________________________________________________
____________________________________________________________________
c. Freezers __________________________________________________________
____________________________________________________________________
d. Janitorial supplies _________________________________________________
Note: Cold storage units must be able to accommodate the number of
meals/ sittings proposed per day. Approximately 0.25 – 0.3 ft3 (.007 - .008 M3)
per meal cold storage and 0.1 – 0.3 ft3 (.003 - .008 M3) per meal freezer space.
9. Cooking Equipment ( list pieces of equipment )
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
10. Menu Type (Full service, sushi/ sashimi, shawarma/donair, buffet, deep fried, snacks,
self-serve, food cart etc.) ______________________________________________
11. Employee clothing storage area ( state where, separate from food service area )
_____________________________________________________________________
12. Water Supply (City, private well etc.)
_____________________________________________________________________
13. Comments/Reason for plan submission (new facility, renovations, addition etc.)
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
Please submit completed application form with plans to:
Environmental Public Health Department
Population and Public Health
101-310 Idylwyld Drive North
Saskatoon SK S7L 0Z2
fax: 655-4498
email: [email protected]
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