Business Variance Request
Complete Instructions:

On March 19th, 2020, Governor Mark Gordon, in conjunction with State Health Officer Dr. Alexia Harrist, ordered the closure of all restaurants, bars, theaters, gymnasiums, child care facilities, K-12 schools, colleges, universities, and trade schools in the State of Wyoming. This order is enforceable under (add local statute numbers here) and failure to comply will result in a fine and imprisonment.

Section eight of the order allows for exemptions to the closure based on the ability for businesses to adhere to certain restrictions.

Please complete this application if you want to request a variance.

Understand that complete of an application is not a guarantee that a variance will be issued. Any variance issued is subject to cancellation or revocation at any time for any reason. Failure to comply with guidance issued with variance will result in loss of variance and possible fines.

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Name of Business
Date of Request
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DD
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Address of Business
Town where business is located
Is this a home based business or commercial business location
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Business Hours
Is business conducted by appointment or walk in?
Business Contact Name
Type of Business
Phone
Email
Please describe how you will limit the number of customers within your business to allow for the 6 foot spacing to be observed at all times. Be as thorough as possible.
Please describe any process for screening for illness of employees or patrons.
Please describe how you will maintain at least 6 feet of space between customers at all times. If unable to maintain the 6 feet requirement, describe through the use of masks how you plan to protect your employees and your customers from exposure. Be as thorough as possible.
Please describe how you will perform sanitation/cleaning between each customer, including names of products used.
All applications are subject to approval by the Lincoln County Health Officer and I understand that if a variance is granted it can be revoked or cancelled at any time for any reason.
Name of Person Completing the Form
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