Tooele Health Department
             
Tooele County Health Department
151 N. Main Street, Suite 140 - Tooele, UT 84074
Phone (435) 277-2440 Fax (435)277-2444

Mobile Food Truck Permit Application

Please put N/A for any fields that are not applicable

Business Information
Organization Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone:
Email:
Name of Business Owner
Phone Number
License Plate Number
Type of Permit
Primary Permit - Tier 1 - $200
Primary Permit - Tier 2 - $350
Secondary - $100
Tier
Two or fewer low-risk TCS Ingredients
More than two TCS Ingredients
Certified Food Safety Manager is required for Tier 2
Commissary Name
Contact Name
Address
Phone
Email a copy of the primary permit to eh@tooelehealth.org (if applying for a secondary permit).


If applying for a Secondary Permit, a copy of the Primary or Yearly Permit will need to be provided with application.
Where was the Primary permit issued?
Date of Expiration
A Primary Permit is valid for one year from date of issue.
Secondary Permits will be the same expiration date as the primary permit.
Applicant agrees to submit a schedule of events and times to the
Health Department at least 72 hours in advance.

ALL EMPLOYEES WILL HAVE A VALID FOOD HANDLERS PERMIT AVAILABLE UPON
REQUEST OF THE LOCAL HEALTH INSPECTOR.

Primary Per Fee - Tier 1:   $200.00   Select:   Item Subtotal:  
$0.00
Primary Permit Fee - Tier 2:   $350.00   Select:   Item Subtotal:  
$0.00
Secondary Permit Fee:   $100.00   Select:   Item Subtotal:  
$0.00
Total:
$0.00
 
Signature of Applicant
Date
Payment Information:
Method of Payment:
 Update Name from Personal/Organizational Information
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
 Change Payment Method
 
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