Mobile Food Service Permit Application

Facility Information:

Architect/Design Professional:

Project Contact:

*Please attach the following required information before a plan review will be started. Incomplete
plans not meeting the following requirements may be subject to additional fees:

1. Site plan

2. Dimensional Floor Plan

3. Proposed Menu

4. Equipment Layout and Schedule

5. Mechanical Schedule

6. Plumbing Schedule

7. Electrical Schedule

8. Equipment Cut Sheets

Max File Size: 2MB

Or for larger files provide a public link to DropBox, or GoogleDrive, so that we can download your files:

New
Remodel
Conversion
Change of Ownership

When were plans submitted to the following authorities:

City/County Business License Division: 

Planning/Zoning: 

Building: 

Fire: 

Other (Please list): 

Proposed Hours of Operation

Expected Number of Meals To Be Served Daily

*It is important to know this information. With this we will know how much space will be needed for refrigeration and dry storage.

Food Supplies
Check categories of Potentially Hazardous Foods (PHF's) to be handled, prepared and served.

Category

A. Thin meats, poultry, fish, eggs (hamburger; sliced meats; fillets) YesNo

B. Thick meats, whole poultry (roast beef; whole turkey, chickens, hams) YesNo

C. Cold processed foods (salads, sandwiches, vegetables) YesNo

D. Hot processed foods (soups, stews, rice/noodles, gravy, chowders, casseroles) YesNo

E. Bakery goods (pies, custards, cream fillings & toppings) YesNo

1. Are all food supplies from inspected and approved sources?YesNo

2. What are the projected frequencies of deliveries for (ex: 2x/week):

3. Provide information on the amount of space (in cubic feet) allocated for:

4. How will dry goods be stored off the floor?

5.Please list foods or categories of foods prepared more than 12 hours in advance of service.

6. Provide a HACCP plan for specialized processing methods such as vacuum packaged food, sous-vide, or cook-chillitems prepared on-site or otherwise required by the regulatory authority.

7. Will the facility be serving food to a highly susceptible population?YesNo

If yes, how will the temperature of foods be maintained while being transferred between the kitchen and service area?

8.Are containers constructed of food-grade materials to store bulk food products?YesNo

1. Does each refrigerator/freezer have a thermometer?YesNo

2. Is there a bulk ice machine available?YesNo

1. What type of temperature measuring device will be used to ensure proper cooking temperatures?

2. How will hot foods be maintained at 135oF (60oC) or above during holding for service? Indicate type and number of hot holding units.

3. How will cold food be maintained at 41oF (5oC) or below during holding for service? Indicate type and number of cold holding units.

4.How will reheating food to 165oF for hot holding be done rapidly and within 2 hours?

Is there a written policy to exclude or restrict food workers who are sick or have infected cuts and lesions?YesNo

[textarea please-describe-brieflyrow1 class:one-col placeholder "Please describe briefly]

Will employees have paid sick leave?YesNo

How will rodents, insects, and other pests be excluded from entry to the establishment?

Will air curtains be used?YesNo

How will cooking equipment, cutting boards, counter tops and other food contact surfaces which cannot be submerged in sinks or put through a dishwasher be sanitized?

Will all produce be washed on-site prior to use?YesNo

Is there a planned location used for washing produce?YesNo

Describe

If not, describe the procedure for cleaning and sanitizing multiple use sinks between uses.

1. Will refuse be stored inside overnight?YesNo

2. Is there an area designated for garbage can or floor mat cleaning?YesNo

3. Is there an area to store returnable damaged goods?YesNo

4. Will a dumpster be used?YesNo

5. Will a compactor be used?YesNo

6. Will garbage cans be stored outside?YesNo

7. Describe surface and location where dumpster/compactor/garbage cans are to be stored

8. Describe location of grease storage receptacle

9. Is there an area to store recycled containers?YesNo

1. Is the water supply:PublicPrivate

If private, has source been approved? Please attach copy of written approval and/or permit. YesNoPending

2. Where are you filling the fresh (potable) water tank?

3. What is the capacity of the fresh (potable) water tank?

4. Is ice made onPremisesPurchased Commercially

If made on premise, are specifications for the ice machine provided? YesNo

5. What is the capacity of the hot water generator?

6. Is the hot water generator sufficient for the needs of the establishment (take into account handwashing, dishwashing, cooking and customer usage)?YesNo

7. Is there a water treatment device?YesNo

If yes, how will the device be inspected & serviced?

1. Where are you emptying your greywater tank at?

2. What is the capacity of the greywater tank?

3. Do you acknowledge that all sewage/wastewater disposal must be done in accordance with all state, federal, and local laws and regulations; Do you acknowledge that no sewage/wastewater may be disposed of down a storm drain or on the ground?* YesNo

1. Are all containers of toxics, including sanitizing spray bottles, clearly labeled?YesNo

2. Where will linens be washed?

3. Where will linens be dried?

4. Location of clean linen storage:

5. Location of dirty linen storage:

6. How will you clean the floor?

1. Will sinks or a dishwasher be used for warewashing?Dishwasher3-Compartment Sink

Is ventilation provided? YesNoPending

Hot Water SanitizingChemical Sanitizing

2. Are there drain boards on both ends of any pot sinks (deep sinks)?YesNo

3. Are test papers and/or kits available for checking sanitizer concentration?YesNo

Is there a hand-washing sink in each food preparation and ware-washing area?YesNo

Do all hand-washing sinks have a mixing valve or combination faucet?YesNo

Is a handwashing sign posted at each handwashing sink?YesNo

When at your various locations of vending, where will you use the restroom?

STATEMENT: I hereby certify that the information in Plan Review Part A & B is correct, and I fully understand that any deviation from the above without prior permission from this Health Regulatory Office may nullify final approval. I acknowledge that the information in Part A & B is not a comprehensive list of all food regulations and that it will be my responsibility to be familiar with and follow all applicable laws and rules.

Approval of these plans and specifications by this Regulatory Authority does not indicate compliance with any other code, law or regulation that may be required federal, state, or local. It further does not constitute endorsement or acceptance of the completed establishment (structure or equipment). A preopening inspection of the establishment with equipment in place & operational will be necessary to determine if it complies with the local and state laws governing food service establishments.

Transaction type: New/Remodeled Facility
Renewal
Transfer of OwnershipSecondary MobileOffsite Catering (Extra Permit Required)

Facility Information

Owner Information

Owner Type:
Sole Owner
Partnership
Corporation
Other:

Digital Signature

By typing your name below, you are signing this form electronically. You agree to, and understand, all the information you are submitting: