REQUIRED FEES BASED ON FACILITY TYPE/PRIORITY *
(Your plan reviewer will assess your facility and assign a type/priority)
COMPLIANCE WITH THE MARYLAND WORKERS’ COMPENSATION ACT
Maryland annotated code, health general article, section 1-202 requires that before any license or permit is issued to an employer to engage in an activity in which the employer may employ a covered individual, the employer must file with the issuing authority a certificate of compliance with the state workers compensation laws; or the employer’s worker’s compensation insurance policy or binder number.
STATEMENT OF WASTE HAULER SERVICE
All food facilities are required to have waste disposed of daily or as often as necessary to prevent a nuisance or unsanitary condition by a method that complies with applicable state and local laws, regulations, and ordinances.
CHECK THE OPTION BELOW WHICH APPLIES TO YOU AND PROVIDE THE REQUESTED INFORMATION: *
STATEMENT OF TOBACCO LICENSEE
Complete this section if you hold a state of Maryland license to sell tobacco-containing products or intend to apply for one.
State of Maryland license number(if known):
Place your initials next to each of the following statements to indicate your understanding: