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Intention to Operate a Food Premises

Online Notice of Intention to Operate a Food Premises Form

*mandatory fields

  • List of Owners or Directors of Corporation (if applicable)
  • MM slash DD slash YYYY
  • If yes, please ensure you check with the municipality regarding zoning.
  • If you answer “yes” to a home-based business on a septic, a septic inspection will be required to ensure your residential septic system is capable of supporting any additional use.
  • Personal Health Information

    Personal information on this form is collected under the authority of the Health Protection and Promotion Act S.O. 1983, C10, and will be used for the provision of recording information for the Community Health Protection Department. Questions concerning the collection of this information should be directed to the Director of Community Health Protection Department of the Health Unit, 458 Laurier Boulevard, Brockville, Ontario K6V 7A3 (613) 345-5685.