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2. New Retail Food Establishment
4. Date: *
   Date:
6. Proposed Name of Establishment*
8. Address of Establishment*
10. Type of Establishment (Bakery, Pizzeria, etc.):*
11. Establishment Phone Number: *
13. Number of Seats:*
14. Square Footage:*
18. Applicant/Owner Information
20. Owner Name:*
22. Owner Street Address: *
24. City/State/Zip Code: *
26. Home Phone Number
27. Cell Phone Number: *

29. By making this application, I (we) agree to comply with all the Ordinances of Woodbridge Township and the State of New Jersey that regulate such establishments. It is further agreed that I (we)shall surrender this license if suspended/revoked by the Health Authority.                      *** License not transferable***

30. Signature and Date:
34. For Health Department Use Only:
36. Date:
37. License Number Issued:
38. Class Type:
40. Amount:
41. Cash or Check
42. Employee Signature/Date:
Leave This Blank:


44. 1. Receive an email copy of this form.
45. Email address

    This field is not part of the form submission.

46. Submit

* indicates a required field