(c) Qualifications and responsibilities of applicants. To qualify for a permit, an applicant shall:

1. (1) Be an owner of the retail food establishment or an officer of the legal ownership;
2. (2) Comply with the requirements of this subchapter;
3. (3) As specified under 20 CAR § 197-402(b), agree to allow access to the retail food establishment and to provide required information; and
4. (4) Pay the applicable permit application fee at the time the application is submitted.

(d) Contents of the application. The application should include:

1. (1) The name, birth date, mailing address, telephone number, and signature of the person applying for the permit and the name, mailing address, and location of the retail food establishment;
2. (2) Information specifying whether the retail food establishment is owned by an association, corporation, individual, partnership, or other legal entity;

3. (3) A statement specifying whether the retail food establishment:

   1. (A) Is mobile or stationary and temporary or permanent; and
   2. (B) Is an operation that includes one (1) or more of the following:

(d) (d) Using time as a public health control as specified under 20 CAR § 192-501(i);

1. (ii) Prepares time/temperature control for safety food in advance using a food preparation method that involves two (2) or more steps which may include combining time/temperature control for safety food ingredients, cooking, cooling, reheating, hot or cold holding, freezing, or thawing;

   1. (iii) Prepares food as specified under subdivision (d)(3)(B)(ii) of this section for delivery to and consumption at a location off the premises of the retail food establishment where it is prepared;

      1. (iv) Prepares food as specified under subdivision (d)(3)(B)(ii) of this section for service to a highly susceptible population;
      2. (v) Prepares only food that is not time/temperature control for safety food; or
      3. (vi) Does not prepare, but offers for sale only prepackaged food that is not time/temperature control for safety food;
2. (4) The name, title, address, and telephone number of the person directly responsible for the retail food establishment;
3. (5) The name, title, address, and telephone number of the person who functions as the immediate supervisor of the person specified under subdivision (d)(4) of this section such as the zone, district, or regional supervisor;

4. (6) The names, titles, and addresses of:

   1. (A) The persons comprising the legal ownership as specified under subdivision (d)(2) of this section including the owners and officers; and
   2. (B) The local resident agent if one is required based on the type of legal ownership;

5. (7) A statement signed by the applicant that:

   1. (A) Attests to the accuracy of the information provided in the application; and

   2. (B) Affirms that the applicant will:

      1. (i) Comply with this subchapter; and
      2. (ii) Allow the regulatory authority access to the establishment as specified under 20 CAR § 197-402(b) and to the records specified under 20 CAR § 192-203(b), 20 CAR § 194-205(c), and 20 CAR § 197-201(d)(4)(G); and
6. (8) Other information required by the regulatory authority.