Application for Moblile Unit Permit or Renewal Permit

For assistance in completing this application, call (903) 683-4688.

PURPOSE OF THIS APPLICATION:

[ ] New Business – Give start date: ______________ [ ] Renewal [ ] Change of Ownership, Effective date: __________

[ ] Amended – Specify type of change [ ] Change of Business Name, or [ ] Change of Physical Location, Effective date: __________

FOOD ESTABLISHMENT INFORMATION:

1. Name Under Which Mobile Unit is operated (DBA):

_______________________________________________________

2. Physical Address of Mobile:	_______________________________________________________________________
	Address Street, For Route–GIVE DIRECTIONS ON REVERSE City Zip

3. Business Contact Person:

____________________________________________

Title:

___________________


4. Email Address For Contact Person:	___________________________________________________________________


5. Telephone Number at Address:	( )_________________	Cell Number on mobile unit:	( )________________

6. Operating Information:	___________m.	to ________________m.	______________________________
	Opening Hours -	Closing Hours of Operations	Days of the week mobile unit will be open

7. Mailing Address (if different):	_____________________________	___________________	____________	________
	Address	City	State	Zip

8. Owner’s Name:

________________________________________________________

Phone #:

____________________

9. Location (s) where you plan to operate mobile unit:

__________________________________________________

FEE INFORMATION: Mobile Food Unit - a vehicle-mounted mobile food establishment designed to be readily moveable.

**A PRE-OPERATIONAL INSPECTION MUST BE PERFORMED AFTER PAYMENT AND PRIOR TO PERMIT ISSUANCE AND OPERATING.**

Indicate Amount Paid

1.	Push Cart (Per Unit).......................................................................................	FEE DUE:	$50.00	_________

2.	Mobile Food Unit (Per Unit)……………………………………………..……..……	FEE DUE:	$100.00	_________

3.	Pre-Operational Inspection Fee for New Mobile Unit or Re- opening Inspection Fee of Existing Unit..................................………….	FEE DUE:	$50.00	_________

4.	Administrative late fee due if renewal application not remitted by January 31^st	FEE DUE:	$50.00	_________

5.	Non-profit establishment required by a State licensing entity to have local inspection..	FEE DUE:	$50.00	_________
	TOTAL FEES PAID			_________

If your business is a Non-Profit entity based on Internal Revenue Code, please submit a copy of your documentation. Permit fees are exempted but an inspection fee is due per inspection required by your licensing entity.

Type of Unit: ( ) Truck ( ) Van ( ) Trailer ( ) Pushcart ( ) Other

Vehicle Identification/Serial No._______________________________________

Unit No. and/or Truck No. ___________________________________________

License Plate No./State ____________________________________________

Description of Vehicle

Make: ___________________ Model: ___________________

Year: __________ Size: __________ Color: ____________

List Foods to be Sold:_________________________________________________________________________

Commissary Address, City/State, Zip: ___________________________________________________________

I certify that the information furnished is true and correct to the best of my knowledge.


Printed Name of Applicant		Title


Signature of Applicant		Date
		(Mobile Unit Form 5/08)

Cherokee County Health Department

Application for Mobile Unit Permit or Renewal Permit

www.cchdtexas.org

FOOD ESTABLISHMENT INFORMATION:

FEE INFORMATION: Mobile Food Unit - a vehicle-mounted mobile food establishment designed to be readily moveable.