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April 2025 Charles Harris, MD-Health Officer MOBILE FOOD ESTABLISHMENT PERMIT APPLICATION Business Name: Location of Commissary or Servicing Station: Owners Name: Owner’s Address: City: State: Zip: Business Phone: Owner’s Phone: Email address: Certified Food Manager: (Copy of certificate must be submitted with application) Please check one: Food Truck ☐ Mobile Cart ☐ ($125 fee for prepare and serve or $75 fee for prepackaged only) Menu Items: **Per Hamilton County Ordinance 16-20-7, each location utilized for food handling and preparation is required to be separately permitted per each business establishment and inspected within Hamilton County. Proof of permit must be provided if product is prepared prior to the event or in another county. A copy of the certified food manager certification is required. Additional information is available by contacting the Health Department. The undersigned applies for a license to operate a mobile food service establishment pursuant to retail food establishment sanitation requirements in 410 IAC 7-26. The undersigned certifies receipt of the guidelines for operation, and that the establishment will be operated and maintained in accordance with these conditions. Owner or Operator’s Signature: Date: Please enclose the following: ☐ Copy of last health inspection ☐ Copy of Certified Food Managers certificate ☐ Copy of Local Health Department permit ☐ Licensed commissary agreement ☐ Floor plan of mobile unit ☐ Employee health policy ☐ Mobile plan review packet ☐ Payment (check, cash, or money order) Please submit all applicable documents mentioned above for a timely review of your application and issuance of a permit. All Mobile units must be inspected by our office. Please allow 30 days for plan review. An inspector will call after plans have been reviewed to schedule a time for the mobile unit to be inspected. You must contact the municipality (city or town) in which you will be operating your mobile to find out if an additional mobile permit is needed to operate in that jurisdiction. Permit SIGN ---PAGE BREAK--- 18030 Foundation Drive, Suite A Noblesville, IN 46060 Phone: (317) 776-8500 Fax: (317) 776-8506 Please complete and return the information below with your permit application and fees. Mobile Unit Type: (Truck, Trailer, Skid, Pushcart, Vehicle Mounted, or Marine Vessel) Unit # (if app) Vin# Plate # Example: Truck 101 1234568A1232 TK1234