HomeMy WebLinkAbout(INC) STOP AND SHOP Foodware Decision FormTOWN OF YARMOUTH HEALTH DEPARTMENT
1146 Route 28, South Yarmouth, MA 02664
508-398-2231 extension 1240
DISPOSABLE PLASTIC FOODWARE DECISION FORM
Application Date: ___________________________________ Issuance Date: __________________________________
Applicant Name: ___________________________________________________________________________________
Business/Organization: _____________________________________________________________________________
Property Address: __________________________________________________________________________________
WAIVER REQUEST DECISION (per the Disposable Plastic Foodware Rules and Regulations for Food Establishments)
☐APPROVED - Waiver is granted. Applicant has demonstrated grounds for a Waiver from these regulations.
☐DENIED - Waiver is denied. Applicant has not demonstrated grounds for a Waiver from these regulations.
Reason:_____________________________________________________________________________________________________
☐NOT APPLICABLE
Conditions of Approval (if applicable): Duration of Waiver (if approved):
VARIANCE REQUEST DECISION (per the Disposable Plastic Foodware Rules and Regulations for Food Establishments)
☐APPROVED - Variance is granted. Applicant has demonstrated that the enforcement of these regulations would create an undue
hardship and that due diligence has been exercised in seeking compliance with these regulations.
☐DENIED - Variance is denied. Applicant has not demonstrated that the enforcement of these regulations would create an undue
hardship and/or that due diligence has been exercised in seeking compliance with these regulations.
Reason:____________________________________________________________________________________________________
☐NOT APPLICABLE
Conditions of Approval (if applicable): Duration of Variance (if approved):
HEALTH AGENT OR DESIGNEE ONLY
Printed Name: Title:
Signature: Date:
NOTICE TO APPLICANT: Any Food Establishment or Takeout Food Delivery Service aggrieved by a decision of the Health Agent,
or designee, on its request for a variance or waiver, may appeal that decision to the Board of Health within 30 days for a public
hearing to amend, overturn, or otherwise modify the decision. The hearing before the Board of Health shall be a de novo review.
.ristina DZyer
//May , 2026
Stop and SKop (Long Pond) / Stop and SKop (Station Ave)
Long Pond Drive / Station Ave
Barry Lewis MBA CHO Assistant Health Director
5/18/2026
October 31, 2026
X
9/30/2026
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