Mobile Food Unit Permit Application

Mobile Food Unit Permit Application
A completed application is to be submitted at least 10 business days prior to planned opening date. Permit fee is due at time of application. Pre-opening inspection does not guarantee a permit will be issued.

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.
Date*

MonthDayYear
Date
Applicant Name*
Applicant must be owner or an officer of the Legal Ownership of the Mobile Food Unit
Date of Birth*

MonthDayYear
Mobile Food Unit Information
Unit/Vendor Name*
Owner Name*
Mobile UnitAnnual Temporary Establishment
Mobile Unit License Plate Number
PartnershipLLCCorporationTax-Exempt EntityIndividual
Mailing Address*
City*
State*
ZIP*
Owner Email*
example@example.com
Owner Phone*
Format: (000) 000-0000.
Owner Fax
Commissary Address
City
ZIP
Commissary Phone
Format: (000) 000-0000.
Commissary Fax
Commissary Hours of Operation
Person in Charge*
Food to be Served
HotdogsBaked GoodsCoffee/TeaBreakfastHamburgersChickenDeliPre-packagedGreekBBQMexicanVegetarianPizzaFishDessertMiddle EasternOther
Thaw frozen productHot or cold holdingReheating for hot holdingCook to orderCook for hot holdingPrepare quantities in advanceServe/sell only pre-packaged potentially hazardous foods
The following items must be approved prior to issuance of a permit.
Water Source and Plumbing
YesNoN/A
YesNoN/A
Potable water tank must be able to store a minimum of 15 gallons.
Size of water supply tank?*
Size of waster retention tank?*
YesNoN/A
YesNoN/A
YesNoN/A
Hand Washing Sink
YesNoN/A
YesNoN/A
YesNoN/A
YesNoN/A
YesNoN/A
YesNoN/A
YesNoN/A
Three Compartment Sink
YesNoN/A
YesNoN/A
YesNoN/A
Walls, Ceilings and Overhead Protection
YesNoN/A
YesNoN/A
YesNoN/A
YesNoN/A
Trash Receptacle
YesNoN/A
Floors
YesNoN/A
Unit Maintenance
YesNoN/A
YesNoN/A
Toxic Materials
YesNoN/A
YesNoN/A
YesNoN/A
Refrigeration/Freezer Units
YesNoN/A
YesNoN/A
YesNoN/A
Hot Folding Units
YesNoN/A
Thermometers
YesNoN/A
YesNoN/A
YesNoN/A
Storage Areas
YesNoN/A
YesNoN/A
YesNoN/A
Equipment
YesNoN/A
YesNoN/A
YesNoN/A
Food-Contact and Non-Contact Surfaces
YesNoN/A
YesNoN/A
Ventilation
YesNoN/A
YesNoN/A
Lighting
YesNoN/A
YesNoN/A
Commissary
YesNoN/A
YesNoN/A
YesNoN/A
Signage
YesNoN/A
Personal Attire
YesNoN/A
Documents Stored on Unit
YesNoN/A
YesNoN/A
Additional Information
Approval agreement (includes written procedure for use) from a commissary owner.

Cancelof
Menu items.*
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 Code, Title II. Chapter 230) 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/Code. 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

Total

$0.00

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

Should be Empty:

Mobile Food Unit Permit Application

Mobile Food Unit Information

Food to be Served

The following items must be approved prior to issuance of a permit.

Water Source and Plumbing

Hand Washing Sink

Three Compartment Sink

Walls, Ceilings and Overhead Protection

Trash Receptacle

Floors

Unit Maintenance

Toxic Materials

Refrigeration/Freezer Units

Hot Folding Units

Thermometers

Storage Areas

Equipment

Food-Contact and Non-Contact Surfaces

Ventilation

Lighting

Commissary

Signage

Personal Attire

Documents Stored on Unit

Additional Information