APPLICATION FOR PERMIT TO OPERATE A

CATERED ELDERLY NUTRITION SITE

(Food prepared off-site)

Name of Facility:
Location Address:
City:	State:	NC	Zip:
Facility phone #:	Email:
Owner of Business:
Mailing Address:
City:	State:	Zip:
Contact Phone #:	Email:
Owner of Building:
Mailing Address:
City	State:	Zip:
Contact Phone #:	Email:

Please specify the following:
Sewer:	Public/Municipal	On-site Wastewater System
Water:	Public/Municipal	Private Water Supply
How many seats will be provided for dining?
Do you plan to serve more than a catered lunch meal? (ex: breakfast)	Yes No
Will you be providing dumpster(s)?	Yes No Or Individual Trash Receptacles? Yes No
Will you be preparing any foods or drinks on-site? Yes No

Please submit the following with the application:

Zoning approval

Letter of agreement from catering facility to deliver meals

Floor plan drawn to scale showing location of hand sink, utensil sink, refrigerator, mop sink, storage areas, bathrooms, garbage storage, etc.

List of floor, walls and ceiling finishes in each room on site including bathrooms.

You will be responsible for obtaining approval from appropriate zoning and building inspection departments. Their numbers are included below to assist you.

ZONING / BUILDING INSPECTION	FIRE MARSHALLS

Shelby 704-484-6805	704-484-6816

Kings Mountain 704-734-4599	704-734-0555

Cleveland County 980-484-4975/4997	980-481-4841

If your business will be located in any jurisdiction other than those listed above, please check with your city manager and/or town hall for permitting assistance.

Proposed opening date:
Date Application Submitted:
Applicant’s Signature:

APPLICATIONS CAN BE SUBMITTED IN PERSON OR BY MAILTO:

Cleveland County Permits Office

1333 Fallston Road

Shelby, NC 28150

Rev. 12/23