SECTION A Q2 gurpreet singh

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Australian College of Trade *

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BSBADM502

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Health Science

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Nov 24, 2024

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docx

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H:\HEALTH\Forms - Public Health\2020-2021 forms\Food Act\Application Form - Food Act Premise.doc Proprietor OR Company Name: (If company please provide certificate of incorporation) APPLICATION FORM - FOOD ACT PREMISES Please COMPLETE and return this application to the Hume City Council Public Health Unit, 1079 Pascoe Vale Rd, Broadmeadows, 3047, together with premise plans (optional) 1. Premises Plans to be sent electronically to healthadmin@hume.vic.gov.au (preferably) DETAIL SELECTION: Applicants Name (s) Given Name: Gurpreet singh Surname: singh Applicants Postal Address 13 bourke Australia Suburb: Postcode12361 Trading name of business Marketing Specialist Address of Food Premises Suburb: Postcode: 12361 Contact Details: Phone 987654321 Mobile: 732659001 Email gurpreet12@gmail.com ABN:23456000011 Applicants Involvement: Proprietor Builder Architect Other (Please specify) …………………………… TYPE OF PREMISES : Warehouse Café/Restaurant Take Away Convenience Store Canteen Manufacturer Low risk packaged food Other (please specify)………………… Mobile Food Van - Food Vehicle Registration number…0987654321……………… OTHER PERMITS Building and/or a Planning permits may be required for your proposed premises, please ensure you obtain the relevant permits prior to commencement of any works. Requirements under other legislation may also be required i.e. local water authority for installation of a grease trap. Applicants must make their own enquires with the relevant bodies. SIGNATURE Print Name: Gurpreet singh Applicants Signature : Gurpreet singh The signing officer must state his/her position of authority in the case of a corporate or unincorporated body of persons, (eg. Company or Partnership). Position: Marketing Specialist _ Date:02 /12 / 23
H:\HEALTH\Forms - Public Health\2020-2021 forms\Food Act\Application Form - Food Act Premise.doc PREMISES PLANS You should submit a copy of the premises plans on A3 or A4 size paper, showing the following items: The use of each area of the premises; The location of all fittings, hand basins, sinks and equipment; Location of the floor waste drain/s, cleaners sink and grease trap; Indicate the nature of the work processes to be carried out in EACH PART of the food premises/vehicle (i.e. storage, preparation, wash-up areas) Details of floors, walls, ceilings, fittings and their finishes; and Provide specifications on the Mechanical Exhaust System. The submission of this application with floor plans for assessment may facilitate the ease of compliance with regulatory requirements, preventing delays in commencement. Prior to opening your food business you will require at least one inspection, to ensure your premises adheres to food safety legislation. Should you have any concerns, please contact the Public Health Unit on 9205 2200. PRIVACY STATEMENT Council collects the personal information on this form so that it may register your premises in accordance with the Food Act 1984. This personal information is used by Council and may be disclosed to the Department of Health (Vic) in connection with the administration and enforcement of the Food Act 1984 / Public Health & Wellbeing Act 2008, but will not be disclosed to anyone else unless required to by law. Access and correction of this personal information can be made via the Public Health Unit on (03) 9205 2200.
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