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Please provide all infoma adore requesi:ed. !fir:incomplete application my delay approval. <br /> Vehicle Marne(DBA): r <br /> Address for Vehicle: <br /> t Stre2EAddee.;s �' � �aD� <br /> i <br /> 1) license Plale : 4) Year <br /> 2) Vehicle Vin <br /> 5) Make/model: # <br /> f 3) Slate Decal G) Color: 1111 <br /> Name: ,L <br /> Address or Owner. l <br /> S4seet Addrass <br /> Ci <br /> ^hE Labile taod`acilRy shaii Operatie out cr?a Caramiiissaly ana shall rapbF.:go she can.Missary at least orae each <br /> oaejmtirtg day for eie-aning -and senricing (GaIGcde sections 194295 114297). to the Use octh cor�rni <br /> I <br /> 'seen,',nuea, , a permit hoider must notify this efee to maiee tae saecessa�� changes. Failure to notice his <br /> i=ce may permit revoca-gor_and pe-mit es. <br /> Signature of Vehicle Operator Date <br /> Cfa, _ p - <br /> Business Name: IC-, � <br /> Oironer Name: �—� '��• � �` T - <br /> Site Address: N 00 C _ <br /> 5�ee�Address <br /> Phone:{�(;rl) (.t fji•t- �� f city <br /> i S 5 <br /> y <br /> -h2 cont= issanj owner,Fara and wile provide he Isecessary iacilii les doe f3ae above-rnenlii©raed ve.icie <br /> comm'Issary as chsr*ed Mow: <br /> £ <br /> Liquid c solUtensil washind waste disposal g sink fO Store frozen food ).' Vehicle wash facillifies <br /> (2 ora compartments) o <br /> [�Preparation of food `` Hot&cold water-,or cleaning [ ToBet&hand washing Q Store refrigerated food <br /> Sto d, food/supplies Provide potable water' Overnight parking Adequate electrical outlet <br /> 4 <br /> 9icnature of Commissa Ownerl0 erator Date <br /> if he 0017ni�issarylfood e5tab is:;ipent.is Outside Sav J©aclu-I t COUra£y,fhe local heatZa jraeisdic�don must ves=t <br /> l-eai4i� pe, ,� by silts-is;c9 heiauv-F_ vow lssafl,0006 est2biishment is in <br /> Y. <br /> Signature of Countif REHS Date- <br /> EHQ1"Ir 5of6 <br /> 7J f 8rZt1Q8 = MFPU APPLICATiO'N <br />