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Application for Permit to Operate
Complete all items that apply to your establishment, sign the application and submit at least 21 days prior to the expected opening date/permit expiration date. A late fee of $50 will be added to total fee if not received in appropriate time
If unsure please contact our office at 786-8894
Choose All that Apply
Shop Permit Covers One Artist at the facility, additional artists must receive their own certification.
Upload copies of the appropriate documentation of compliance with the Worker's Compensation Law
Make check payable to the Wyoming County Health Department:5362 Mungers Mill RoadSilver Springs, NY 14550
Note* Payment may be made online by clicking the link. If payment is not made online the form must be printed and mailed to our office with appropriate fee.
Please pay amount associated with your Permit type and any associated operations included on your permit.
Failure to sign this form may delay issuance of your permit to operate. Operation without a valid permit is a violation of the State Sanitary Code.
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