2. REQUEST FOR FOOD SERVICE VARIANCE
   JCPH may grant a variance to any section of the regulations when: (1) No health hazard would exist as a result of this action; (2)The variance is consistent with the intent of these regulations.
4. A variance request fee must accompany this application.
   Current Fees
5. Statutory Authority:
   RCW 43.20.050. 92-08-112 (order 261B) WAC 246-215-270 Jefferson County Code Title 8.05
7. Date of Request:*
   Date of Request:
8. Applicant:*
9. Email Address:*
11. Type of Food Service: *
    -- Select One --RestaurantMobileCateringOther
12. Category*
    -- Select One --123
13. Category Descriptions
    Category Descriptions

    
    
    
    

15. Establishment Name*
16. Phone Number*
18. Establishment/Commissary Address*
19. City*
20. Zip Code*
21. State*
23. Mailing Address*
24. City*
25. Zip Code*
26. State*
30. Variance Request
    A variance is an exception from the general rule or regulation and as such must be accompanied by sufficient reasoning to justify granting its approval. The following questions will assist in the evaluation of the variance request. Attach additional sheets, diagrams, etc. as necessary.
32. From which regulation are you requesting a variance?*
34. Describe the extraordinary conditions or unusual circumstances which exist that would justify deviation from the standard.*
36. Is the variance necessary to accomplish your project or is there another reasonable way to accomplish your project that would not require a variance? (Please explain.)*
38. Is there anything else you would add which supports your request?*
40. Attach any additional information (reports, studies, maps, illustrations, leases, permits, etc.) that may further describe the proposed variance in addition to the site plan.
41. Attachment 1
42. Attachment 2
44. ACKNOWLEDGMENT*
    By typing my full name, I hereby declare that I am the applicant or authorized representative and the information provided in this application is true and correct to the best of my knowledge. Furthermore, I acknowledge that I cannot proceed with the proposal until JCPH has approved the variance.
45. Date of Submission*
    Date of Submission
49. For Official Use Only
51. Resolution:

    ___ Granted

    ___ Denied

52. Signature:

    ______________________________

    EH Manager/Director

53. Date:

    _______________

Leave This Blank:


55. 1. Receive an email copy of this form.
56. Email address

    This field is not part of the form submission.

57. Submit Submit and Print

* indicates a required field