Type Of Facility:
Elementary (state grades)____________
Secondary (state grades) _________
Post secondary (specify area of instruction)_____________
Accredited by State Department of Education?
Maximum number of students at any one time:_________ Number of students enrolled: _______
Do you intend to prepare/serve meals?
No (Bag and snacks are excluded from food service license)
Water supply: r Public
Days and Hours of Operation: ______________________________________________________________
NEW FACILITIES OR CHANGE OF LOCATION FOR EXISTING FACILITIES:
Anticipated date of opening or change of location: ____________________________________________
Person to contact to arrange for an inspection:________________________________________________ Name Daytime Phone Number
Attach a copy of the Use and Occupancy permit for school use to this application. To obtain, call the Office of Use and Occupancy, 240-777-6240.
Attach a copy of the Fire inspection approval call 240-777-2457 to schedule for a fire inspection with the Fire Prevention Bureau/Fire Marshal office.
Fee Information: Please refer to Tanning Fact Sheet
Submit completed application and application fee to Licensure and Regulatory Services, 401 Hungerford Drive, 1st
Floor, Rockville, Maryland 20850. Payment must be made by check or money order, payable to “Montgomery
County, Maryland”. We are unable to accept cash payments.