Tobacco Retailer: Permit Applications


General Tobacco Retailer 

General Tobacco Retailers typically sells a wide variety of products so that the sale of tobacco products accounts for less than 35% of the total quarterly gross receipts. Examples include  convenience stores, grocery stores, etc.

I understand that in order to be permitted as a General Tobacco Retailer, the business identified in this application MAY NOT at any time:

Have any self-service display of tobacco products; or

Have 20% or more of the total retail floor space allocated to the offer, display, or storage of tobacco products; or

Have 20% or more of the total shelf space allocated to the offer, display, or storage of tobacco products; or

Have 35% or more of total quarterly gross receipts from the sale of tobacco products.

Retail Tobacco Specialty Business

Retail Tobacco Specialty Business specializes in the sale of tobacco and or vaping products.

I understand that in order to be permitted as a Retail Tobacco Specialty Business, the business identified in this application anticipates:

35% or more of the total quarterly gross receipts from the sale of tobacco products, or

20% or more of the retail floor space allocated to the offer, display, or storage of tobacco products, or

20% or more of the total shelf space is allocated to the offer, display, or storage of tobacco products, or

the retail space features a self-service display for tobacco products.

The business identified in this application MAY NOT at any time, be within:

1,000 feet of a community location; or

600 feet of another retail tobacco specialty business; or

600 feet of property used or zoned for agricultural or residential use.

Note: Businesses licensed and conducting business prior to December 31, 2015 may not be in compliance but qualify to maintain business due to grandfathering

Please refer to UCA 59-14-102; UCA 76-10-101; and UCA 76-10-104.1 for specific definitions of tobacco products.

Please refer to UCA 17-50-333 for a complete list of community locations public or private

PROPRIETOR INFORMATION

General Tobacco Retailer
Tobacco Retailer Specialty Business
Map of Proposed Location for Retail Tobacco Specialty Business
* Name
* Street 1
Street 2
* City
* State
* Postal Code
* Phone
* Email
* Authorized to receive permit-related
communications and notices
Name
Street 1
Street 2
City
State
Postal Code
Phone
Email
Authorized to receive permit-related communications and notices
* Business Name
* Street 1
Street 2
* City
* State
* Postal Code
* County
* Phone
* Email
* Tax Commission Tax License

Has any of the proprietors applying for a tobacco license listed above been determined to have violated any state or federal
tobacco laws in the past 24 months? If so, list all violations and dates of each violation:

I certify that the information provided is true and accurate to the best of my understanding. I
understand that any incorrect information may result in the suspension or revocation of the
health department’s tobacco permit. I also understand that the health department may
recommend to the business licensing entity that the business license be suspended or revoked.
Any such action will be reported to the Utah State Tax Commission.

Payment must be submitted with the application. No permit will be issued without the payment
of the permit fee. A plan review will not be conducted until payment of the plan review fee. It is
the responsibility of the applicant to verify zoning restrictions. Fees cannot be refunded if it is
later determined that the identified location does not meet zoning requirements.

* required fields