E-APPLICATION AND LICENSING
Developed By CPUI
Ver 01/30/2018
Kandiyohi-Renville Community Health Board
2200 23rd Street NE Suite 1080, Willmar, MN 56201
www.co.kandiyohi.mn.us — www.co.renville.mn.us
Kandiyohi County: 320.231.7800
Renville County: 320.523.2570
publichealth@co.kandiyohi.mn.us — rcph@renvillecountymn.com
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2019 MOBILE FOOD UNIT APPLICATION

Establishment Information

Applicant/Owner Information

Mailing address if different than above:

Workers Compensation Information:

Pursuant to Minnesota Statutes 176.182 & 270.72, the following applicable information is required of each license applicant:

Definitions:

Food Cart - A food and beverage service establishment that is a non-motorized unit, operating no more than 21 days annually at any one place or is operated in conjunction with a permanent licensed business at the site of the permanent business by the same individual or company, and readily movable, without disassembling, for transport to another location.

Mobile Food Unit - A food and beverage service establishment that is a vehicle mounted unit, either motorized or trailered, and readily movable, without disassembling, for transport to another location. The unit can operate no more than 21 days annually at any one place unless it is operated at the site of and in conjunction with a permanent business licensed under Minnesota Statutes Chapter 157 or Chapter 28A.

Seasonal Permanent Food Stand - A food and beverage service establishment which is a permanent food service stand or building, but which operates no more than 21 days annually.

Seasonal Temporary Food Stand - A food and beverage service establishment that is a food stand which is disassembled and moved from location to location, but which operates no more than 21 days annually at any one location.

FEE SCHEDULE

MAKE CHECKS PAYABLE TO: KANDIYOHI-RENVILLE COMMUNITY HEALTH BOARD

Check the appropriate boxes:

………………………………………………………. $226

……………………………………………… $226

………………………………. $226

……………………………………….... $226

Submit this total with application: Total Fee $
0

Please attach additional information as needed

Complete all applicable information or application will be returned.

Drop files here to upload
If form needs resubmission all files will be saved, but not shown
except in the case of session expiration

This is to certify that I am the individual who is the subject/business owner of the requested application.

This statement is to certify that all of the information in this application is true and correct and has been provided by the above named subject/business owner.

I certify that the information provided on this application is accurate and complete.

Online Application Completed

Enter in your federal tax ID to prepopulate the form with last years values