MHP/RCA Plan Review Form

Kandiyohi-Renville Community Health Board
2200 23^rd 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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2024 MFU, STFS, SPFS, FOOD CART PLAN REVIEW APPLICATION

ESTABLISHMENT INFORMATION

Business Name:

Telephone (business):

OWNER

Name:

Mailing Address:

City: State:

Zip:

Telephone:

Email:

Contact person for all plan review correspondence

Applicant's Name:

Mailing Address:

City: State:

Zip:

Telephone:

Email:

Review Kandiyohi-Renville Construction Guidelines for all construction requirements.

Failure to submit plans and appropriate fees for new construction or remodeling will not prevent the fees from being collected. In addition, any construction not meeting code will have to be corrected prior to opening.

CONSTRUCTION DATES

Anticipated Start:

Anticipated Completion:

Check One:

Food Cart

Mobile Food Unit

Seasonal Permanent Food Stand

Temporary Food Stand

PLEASE INCLUDE:

Floor plans

Drawn to scale

Show equip location

Room Finish Schedule

Floors, walls, ceilings

Equipment listing

Manufacturer name

Model number

Plans submitted without the above information will be considered incomplete.

SUBMIT PLUMBING PLANS TO:

MN Dept. of Labor & Industry

Plumbing & Engineering

443 Lafayette Road N

St Paul, MN 55155-4343

(651) 284-5063

Fee: $

The Plan Review Fee is equivalent to the establishment's license fee. Fees must be submitted with this application.

Make checks payable to: Kandiyohi-Renville Community Health Board; mail to address above.

Review Kandiyohi-Renville Construction Guidelines for all construction requirements.

Blue prints of the grounds must be submitted. They must be drawn to scale and include: each lot, water source, toilet, showers, roads, sewage treatment system, park shelter, etc.

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

ByDate