2. 

   CHARTER TOWNSHIP OF LENOX

   FOOD TRUCK PERMIT APPLICATION

   63775 Gratiot Ave.

   Lenox, MI 48050

4. Business Name*

   Name of Business Operating the Food Truck

5. Date of Application*
   Date of Application
7. Address*
8. City*
9. State*
11. Phone(s)*
12. Email*
16. Description*

    Description of Mobile Food Vending Unit (Including dimensions). Mobile unit can not exceed thirty feet (30') in length or ten feet (10') in width.

18. Make of Vehicle*
19. Model*
21. Description of the preparation method and food product offered for sale.*
23. Copy of Menu*
27. Location(s) of Operation*
29. Date(s)/Hours of Operation*
    Date(s)/Hours of Operation Start Date

    Date(s)/Hours of Operation Start Time

    —

    Date(s)/Hours of Operation End Date

    Date(s)/Hours of Operation End Time
31. Type of Permit Requested*

    1. Day Permit | Please list the number of days requested and the dates requested below
    2. Weekly Permit | Please list the dates requested below
    3. Monthly Permit | Please list the dates requested below
33. Dates Requested*
37. Please describe how utilities will be connected:
39. Electrical Access*
41. Water Supply*
43. Waste Water Disposal*
45. Are there any written property use agreements? If so, please explain:*
49. Please provide the following:
51. Current Vehicle Registration*
52. Copies of all necessary licenses or permits issued by Macomb County and the State of Michigan*
54. Proof of General Comprehensive Liability policy with limits of no less than $2 million (two million) Combined Single Limited Coverage issued by an insurer licensed to do business in the State of Michigan and which name the Township as an additional injured
56. Proof of Public Liability and Property Damage motor vehicle policy with limits of no less than $1 million (one million) issued by an insurer licensed to business in the State of Michigan*
58. Copy of licenses and permits issued by the Macomb County Health Department including a copy of the "letter of intent" provided to Macomb County*
60. ELECTRONIC SIGNATURE*
61. Date*
    Date

    Date
Leave This Blank:


63. 1. Receive an email copy of this form.
64. Email address

    This field is not part of the form submission.

65. Submit

* indicates a required field