Annual Temporary Food Stand Permit Application

Annual Temporary Food Stand Permit Application
If application is not submitted 10 business days prior to event, you may be required to come to the health department during normal business hours.

PLEASE NOTE: Filling out this application does NOT guarantee you permission to operate. You MUST contact the Platte County Health Department and schedule an inspection in order to complete this application process.
Mobile Food Unit Information
Mobile Food Unit Name*
Owner/Owner Agent Name*
Mobile UnitAnnual Temporary Establishment
Mailing Address*
City*
State*
ZIP*
Owner/Owner Agent Email*
example@example.com
Owner/Owner Agent Phone*
Format: (000) 000-0000.
Will You Be Utilizing a Commissary?*
Commissary Address
City
ZIP
Commissary Phone
Format: (000) 000-0000.
Additional Information
Menu Items*
Copy of Commissary Agreement

Cancelof
If the commissary is not within the jurisdictional area of PCHD, the following is required.
Copy of Commissary Health Permit

Cancelof
Copy of Commissary Last Inspection

Cancelof
List of Locations Where Unit May Serve*
I, the undersigned, attest to the accuracy of information provided in this application and understand that any misrepresentation or omission of fact will render this application and any permit issued as invalid. I am familiar with the requirements of the Missouri Food Code and Platte County's local food protection ordinance (Platte County Missouri Government Ordinances Chapter 230: Food Service Establishments and Retail Food Establishments) and I understand that my food permit may be suspended or revoked by the Platte County Health Department for failure to comply with the provision in the ordinance. Once approved, I understand the mobile food unit permit is not transferrable from one person to another, from one location to another, or from one type of food service operation to another.
Signature of Applicant*

Clear
Date*

MonthDayYear
Date

Permit Fee*

Permit Fee

$100.00 Quantity

Total

$0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Annual Temporary Food Stand Permit Application

Mobile Food Unit Information

Additional Information