E-APPLICATION AND LICENSING
Developed By CPUI
Ver 01/30/2018
Kandiyohi-Renville Community Health Board
2200 23rd Street NE Suite 1080, Willmar, MN 56201
www.co.kandiyohi.mn.us — www.co.renville.mn.us
Kandiyohi County: 320.231.7800
Renville County: 320.523.2570
publichealth@co.kandiyohi.mn.us — rcph@renvillecountymn.com
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2019 MHP/RCA PLAN REVIEW APPLICATION


ESTABLISHMENT INFORMATION

Water Supply System:

Sewage System:

OWNER

Contact person for all plan review correspondence

Notices should be sent to:

CONSTRUCTION DATES

The Plan Review Fee is equivalent to the establishment's license fee. Fees must be submitted with this application.

Make checks payable to: Kandiyohi-Renville Community Health Board; mail to address above.

Review Kandiyohi-Renville Construction Guidelines for all construction requirements.

Blue prints of the grounds must be submitted. They must be drawn to scale and include: each lot, water source, toilet, showers, roads, sewage treatment system, park shelter, etc.

Failure to submit plans and appropriate fees for new construction or remodeling will not prevent the fees from being collected. In addition, any construction not meeting code will have to be corrected prior to opening.

Drop files here to upload
If form needs resubmission all files will be saved, but not shown
except in the case of session expiration

This is to certify that I am the individual who is the subject/business owner of the requested application.

This statement is to certify that all of the information in this application is true and correct and has been provided by the above named subject/business owner.

I certify that the information provided on this application is accurate and complete.

Online Application Completed