Restaurant Permit Application

License Application for - Restaurant

MUNICIPAL CODE SECTION – 4-45 (SEE ALSO 4-46)
South Bend Municipal Code: Section 4-45 and 4-46

GENERAL INSTRUCTIONS:
1. Thoroughly review all applicable Municipal Codes, Click here to review the ordinance.
2. Include a copy of the St. Joseph County Health Permit
3. Licenses expire March 1st for restaurant names beginning with letters A-M; Licenses expire April 1st for restaurant names beginning with letters N-Z.
4. $5.00 application processing fee made payable to City of South Bend.
5. License fee payable to City of South Bend - $90.00 if 150 seats or less; $110 if more than 150 seats; $30.00 added to above fees for live entertainment.
6. If renewed after the expiration date, a 10% late fee will be assessed on the license fee
7. In addition, the city may impose a $50.00 fine for each day that you operate without renewing the business/occupational license.
8. See §4-46 if live music/entertainment is provided.
REQUIRED INFORMATION AND MATERIALS:
1. Health Permit pursuant to inspection and approval by County Health Officer.
2. Must comply with Fire and Building Department Inspections as required by City Controller.
3. Valid certificate signed by Sealer of Weights and Measures if food to be sold by weight or measure.
4. Must comply with minimum sanitation requirements as specified by Indiana State Board of Health, Regulation HFD 17 and all changes and amendments (available on file with City Clerk).
5. If applicant is a not-for-profit organization, provide proof of status.
APPLICATION PROCESS:
1. Submit Application with $5.00 Processing Fee; this can be submitted over the phone if renewed online.
2. Inspection and approval by the County Health Officer, as evidenced by a valid Health Permit
3. Inspections by the Fire Department and Building Department as required.
4. Applicants desiring to sell food by weight or measure shall file a valid certificate signed by the Sealer of Weights and Measures that all scales and measures to be used in said business have been tested and approved, at the time of making application.
5. License issued upon approval and payment of the license fee.

Application Type
Is this application pertaining to a new restaurant or are you renewing your existing permit?*

New PermitRenew Permit
Business Data
Business Name*
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Does Mailing address differ from Property Address?*

Yes, different addressNo, Same address
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Business Email Address*
example@example.com
Type of Zoning at Business Location
Use the Zoning Map to determine your business's Zoning Type.
Number of Employees*
Maximum Seating Capacity*
Do you provide Live Music or other Live Entertainment?*

Yes, there is live entertainmentNo
What type of Live Entertaiment do you provide?*
Do you have pool tables?*

YesNo
How many pool tables do you have?*
If you have four or more pool tables, you are also required to have a Pool Hall License.
General Questions
Will the food be sold by weight or measure?*

YesNo
Upload certificate from the Sealer Weights and Measures.

Cancelof
Is your restaurant operated by a not-for-profit fraternal organization, service club, or religious, educational, or charitable institution?*

YesNo
Upload proof of not-for-profit status

Cancelof
Upload a copy of your St. Joseph County Health Department permit.

Cancelof
Personal Data
Applicant's Legal Name*

First NameMiddle NameLast Name
Applicant's Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant Home Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Applicant Cell Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Applicant Email*
example@example.com
Position with Business*
Are you the owner?*

YesNoYes, and there is another owner.
Owner's Legal Name*

First NameLast Name
Owner's Residential Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Owner's Home Number*
Please enter a valid phone number.Format: (000) 000-0000.
Owner's Cell Number*
Please enter a valid phone number.Format: (000) 000-0000.
Owner's Email*
example@example.com
Signature
I, hereby, certify and affirm that all the information I have given in this application is true and accurate to the best of my knowledge. I further certify that I have in no way attempted to mislead the City in this application by omitting facts known to me. I have read and understand the regulations of the Restaurant license found in the City of South Bend Municipal Code, Sections 4-45 and 4-46.
Electronic Signature*

First NameLast Name
Date*

MonthDayYear
Date
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License Application for - Restaurant

GENERAL INSTRUCTIONS:

REQUIRED INFORMATION AND MATERIALS:

APPLICATION PROCESS:

Application Type

Business Data

General Questions

Personal Data

Signature