Food Plan & Review Application

Department of Health · St. Joseph County, Indiana

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Edit the agency’s original form, save your draft, attach documents, and review your completed PDF before signing or ordering delivery.

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Your application steps6 steps · Department of HealthView steps

1Prepare your answersComplete here
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Official source
2Add supporting documentsComplete here
Attach the supporting records listed by the agency. Check that every page is legible and complete.
- Complete the application and questionnaire in full; submit standard/scaled drawings.
- Submit a proposed menu (with consumer advisory where applicable), equipment specification sheets and site plan.
- Attach relevant certificates, public-health time-control procedures, alternative washing procedures or wastewater approval when applicable.
- Include a floor plan with dimensions of kitchen, dishwashing, dry storage, preparation, restrooms, dining and customer-service areas plus equipment/plumbing fixture locations.
3Review and signPrepare here, finish outside
Complete each applicable applicant signature after reviewing the full declarations. Required notary, professional and witness signatures remain separate.
4Choose paymentPrepare here, finish outside
Plan/review tiers: under 3,000 sq ft $100; 3,001–30,000 $180; 30,001–40,000 $260; 40,001–60,000 $340; 60,001+ $400. Current schedule excludes the $85 application fee and annual permit fee; the older application says a $75 fee is included. Confirm the total. Government fees are separate from the optional prepared PDF and postage. Review the exact amount and recipient before authorizing a check.
Pay the agency directly
5Submit or order deliveryPrepare here, finish outside
Complete the official application and supporting documents. The county online application redirects to the Food Services Payment Form. Confirm applicable total fees and the current receiving floor before sending a mailed packet.
Official submission instructions
6Keep your receiptComplete here
Save your agency confirmation and payment receipt. Track any mailing from My applications. Delivery does not mean the agency approved your application.

Official requirements and sources

Food Plan & Review Application
Original PDF: mapped applicant inputs, retained instructions, fee schedule and office-only areas.
County Forms, Permits & Licenses
Names this DocuSign application under Food Permits; instructs applicants to allow redirection to Food Services Payments after application completion.
Current Department of Health fee schedule and payment policy
Business checks, cashier checks and money orders are accepted by US mail and made payable to St. Joseph County Department of Health; personal checks are not accepted. Card transaction charge is 2.55% or $1.55, whichever is greater.

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Page 1 of 11 · 28 editable blanks

Revised 04/16/2025 St. Joseph County Department of Health Food Service/Store Establishment “Plan and Review” Application Date of Application: Project type: New Renovation Conversion Note: Please submit standard drawings with this “Plan and Review” Application. See Instructions on Page 2, for completing the “Plan and Review” Questionnaire. Also see the “Fee Schedule” on Page 10 to determine the fee to submit. Name of Establishment: Category: Restaurant Institution Retail Market Other (if other, please specify): Address of Establishment: City: State: Zip: Establishment Telephone: Fax: E-Mail Address: Applicant’s Name if Different from Owner: Title (owner, manager, architect, etc.): Mailing Address: City: State: Zip: Telephone: Fax: E-Mail: Printed Name of Person Completing Application Date Signature of Person Completing Application For office use Only Date Received: Application Fee Amount: Transaction # Department Employee: 1

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Before you begin

Application checklist

Complete the application and questionnaire in full; submit standard/scaled drawings.
Submit a proposed menu (with consumer advisory where applicable), equipment specification sheets and site plan.
Attach relevant certificates, public-health time-control procedures, alternative washing procedures or wastewater approval when applicable.
Include a floor plan with dimensions of kitchen, dishwashing, dry storage, preparation, restrooms, dining and customer-service areas plus equipment/plumbing fixture locations.

Published government feesPlan/review tiers: under 3,000 sq ft $100; 3,001–30,000 $180; 30,001–40,000 $260; 40,001–60,000 $340; 60,001+ $400. Current schedule excludes the $85 application fee and annual permit fee; the older application says a $75 fee is included. Confirm the total.

The original fee table leaves exactly 3,000 square feet unspecified; confirm that boundary with the Department of Health.

Fee conflict: original plan-review packet says $75 administrative fee included; current county schedule says plan fees exclude the application/administration and annual permit fees, and lists application fee $85. Agency must confirm the current total.

Official requirements Official source form

Source version: 2026-10-05.regional-1

Your work stays yours

Application answers and files are encrypted in private storage. Authorized service managers can review signing history and documents to process your request.