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Bakery License Application

The document is an application for a bakery license from the State of Connecticut Department of Consumer Protection that requires applicants to provide business and location details, pay a fee based on the number of production workers, and obtain zoning approval for the bakery location. It instructs applicants to complete all fields, submit payment, and return the form to the address provided for review and processing.

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42 views

Bakery License Application

The document is an application for a bakery license from the State of Connecticut Department of Consumer Protection that requires applicants to provide business and location details, pay a fee based on the number of production workers, and obtain zoning approval for the bakery location. It instructs applicants to complete all fields, submit payment, and return the form to the address provided for review and processing.

Uploaded by

nickjosh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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For Official Use Only


FOODS, Rev 10/13

STATE OF CONNECTICUT
DEPARTMENT OF CONSUMER PROTECTION
Food & Standards Division
Telephone: (860) 713-6160
Email: [email protected]
Web Site: www.ct.gov/dcp

APPLICATION FOR LICENSE - BAKERY


INSTRUCTIONS:
All spaces must be completed - please print or type. This application must be accompanied by a check or money order for the
appropriate fee as listed below made payable to: “Treasurer, State of CT.” Application fees are non-refundable.
Return your completed application and fee to:
Department of Consumer Protection, License Services Division, 165 Capitol Avenue, Hartford, CT 06106
Bakery License Fee: (Based on *Number of *Number of production workers is defined per CT General Statute 21a-152 as “...the number
Production Workers) 10 - 24 = $ 100.00 of persons engaged in the production of bread and pastry products, excluding
1 - 4 = $ 20.00 25 - 99 = $ 200.00 porters,dishwashers, drivers, sales personnel and other employees not directly engaged in
5 - 9 = $ 40.00 100 + = $ 250.00 such production.

Business Trade Name (dba)

Physical Location of the Production/Storage Facility - Street Address City State Zip Code

Telephone Number (with area code) FEIN Previous License Number (if applicable)

Corporation Name (If Applicable)

Mailing Address (if different than above)


Street Address City State Zip Code

Applicant’s Name & Title Applicant’s Email

*Number of Production Workers: Public or Private Water Supply Waste Water Disposal System

Private Well Public Supply Septic System Public Sewers

___________
Product Storage Requirements: _____________ _______________
Sales Type (check all that apply):

Shelf Stable Refrigerated/Frozen Both Wholesale Retail

Certificates of approval shall be obtained from the local authority of the town, city or borough where the
business is located or is proposed to be located. Certificates of approval shall not be required for locations
where a previously approved food facility has been operating.

Check one, as applicable


ZONING APPROVAL NOT REQUIRED
ZONING APPROVAL FOR BAKERY
THIS IS TO CERTIFY THAT UNDER THE PROVISIONS OF SECTION 21a-152 OF THE GENERAL STATUTES, (I) (WE) HAVE
APPROVED THE LOCATION OF THIS BAKERY:

Signed: ___________________________________________________ Title: ________________________________________


Chairperson of Zoning Board or Other Town or City Official Date Signed: _________________________________
I subscribe and affirm under the penalties of perjury, that the statements made in this application have
been examined by me and to the best of my knowledge and belief are true and correct.

Signature of Applicant Date

FOR OFFICIAL USE ONLY


INSPECTION DATE : INSPECTED BY : APPROVED BY : APPROVAL DATE :

FEE DUE : FEE COLLECTED : CHECK OR MONEY ORDER #: TOWN TAX CODE :

RENEWAL NEW LICENSE YEAR : EFFECTIVE DATE : EXPIRATION DATE :


APPLICATION APPLICATION

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