Forms and Applications

The forms in this section are provided in PDF format. In order to view and print them, you may need to download and install Adobe Acrobat Reader.

Child Care Center

Child Care Plan Review Application

The information required on this form is to be submitted with plans for child day care centers in Mecklenburg County. The information is needed to allow a complete review of plans for new construction or remodeling of existing facilities.

Home Day Care (aka Family Child Care Home)

HDC Application 

Home day care fa​cilities in Mecklenburg County are regulated by the Health Department. This form must be completed and submitted, with the appropriate payment, before a permit to operate a home day care facility will be issued. For additional information, please visit the child day care home page.

Nursing Home, Assisted Living, and Other Institutions

Institution Plan Review Application

"Institution" includes the following establishments providing room or board and for which a license or certificate of payment must be obtained from the Department of Health and Human Services, other than those operated exclusively by the State of North Carolina: (a) hospital, as defined in G.S. 131E-76 including doctors' clinics with food preparation facilities; (b) nursing home, as defined in G.S. 131E-101; (c) sanitarium, sanatorium, and any similar establishment, other than hospital and nursing home, for the recuperation and treatment of 13 or more persons suffering from physical or mental disorders; (d) adult care home, providing custodial care on a 24-hour basis for 13 or more persons, including homes for the aged; (e) orphanage, or children's home providing care on a 24-hour basis for 13 or more children.

LFSE Application 

"Limited Food Service Establishments," are typically concession stands that prepare and serve food only at an amateur athletic event. Permits for limited food service establishments can only be issued to: 

• Political subdivisions of the State (towns, cities)
• Establishments operated by volunteers that prepare or serve food at amateur athletic events
• Establishments operated by organizations that are exempt from federal income tax under section 501(c) (3) or section 501(c) (4) of the Internal Revenue Code
• Lodging facilities that serve only reheated food that has already been pre-cooked

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 Lodging Establishments

Lodging Plan Review Application (2018)

"Lodging establishment" means all hotels, motels, inns, tourist homes, and other places providing lodging accommodations for pay. Facilities described in G.S. 130A-250 (1) through (5) are not regulated as lodging establishments.

 Public Swimming Pools
 

Click here for all public pool related information and forms.

 

​Pushcart/Mobile Food Unit Application

Pushcarts and mobile food units require a permit prior to beginning operation. This form is used to identify the unit operator and ensure that an approved commissary is secured from which the unit will operate. For additional information, please visit the mobile food unit and pushcart page

Mobile Food Unit/Pushcart Route Update Form

This form is u​sed to notify the Health Department that the route for a permitted mobile food unit or pushcart has been modified. For additional information, please visit the mobile food unit and pushcart page.

School Buildings

School Building Application.pdf

This form is used for new public and private school establishments (Serving grades K - 12)

Residential Care

Residential Care Application

Residential care inspections are requested by the agency holding the license. This form is to be used for requesting inspection for new facilities and renewal of existing facilities.

Residential Pools

Residential Swimming Pool Application​Application Instructions Plot Plan

The regulations require approval to construct a swimming pool and comply with minimum swimming pool barrier (fence) protection, proper disposal of backwash water, and pool setbacks from onsite water supply (wells) and wastewater disposal systems (septic tank systems).

Temporary Food Establishments

Temporary Food Service Facilities must operate in conjunction with a public event and be located on the event grounds. An application must be completed and reviewed before Environmental Health staff will issue a permit for operation of a temporary foodservice facility. For more information please visit the Temporary Food Establishment page.

Information is required from the organizer of a circus, carnival, festival, or similar public gathering where food will be sold. This information is needed to allow Health Department staff to ensure that food service operations can be conducted while minimizing potential risk to the public. The application should be returned to the Health Department as soon as possible, but at least 2 weeks prior to the event. For more information please visit the Temporary Food Establishment page.

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