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2. 
5. City of Lino Lakes Application for Mobile Food Vendor

   Application Fee

   • $50 - Inspection completed during business hours
   • $75/hr. (2 hr. minimum) - Inspection completed after business hours

   Fee may be waived with current Anoka County fire inspection.

   Checks and money order payable to "City of Lino Lakes." VISA, Mastercard, and Discover are accepted.

   Note: If you have obtained an Anoka County Mobile Food Unit Inspection Reciprocity Sticker please upload a picture of the Reciprocity Sticker. Upon verification, your application will be approved without collecting the fee.

7. Reciprocity Sticker (if applicable)
11. Applicant Information
13. First and Last Name*
14. Date*
16. Address*
18. City*
19. State*
20. Zip Code*
22. Email Address*
23. Phone*
27. Business Owner Information (if different than Application Information)
29. Business Owner Name
31. Address
33. City
34. State
35. Zip Code
37. Phone Number
38. Email Address
40. Primary Vending Address / Location Description*
42. Days and Hours of Operation*
43. Describe the Principal Products Rendered*
47. Vehicle Information
49. Year, Make, and Model of Vehicle Used*
51. Mobile Food Preparation Vehicle Name*
52. License Plate Number*
56. Accompanying Documents

    Please supply a copy of the following documents below. Check off the ones that you are able to provide at this time.

    1. A current MN Department of Health Certificate (if needed)
    2. A current MN Department of Health Food Manager Certification
    3. A current Anoka County Health Certificate and Food Establishment Certificate
    4. All Insurance Certificates (Vehicle and Liability)
57. Upload Corresponding Files
59. Acknowledgements *

    Please confirm that you acknowledge the following statements by checking the boxes: 

    1. I have read and will obey all rules and regulations relating to mobile food vendor operations, locations, an all other requirements.
    2. I will have a current certified fire extinguisher within the vehicle at all times.

61. The data you provided on this application will be used by the City of Lino Lakes to assess your qualifications for a permit. After issuance of a permit, all information contained in this application, will be public information pursuant to Minnesota Statutes, Chapter 13.

    By signing below you certify or declare under penalty of perjury under the laws of the State of Minnesota that the foregoing is true and correct. All information given is subject to verification by the State of Minnesota. 

63. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
64. Date and Time*
    Date and Time

    Date and Time
66. Electronic Signature*
67. Confirmation and Fee

    You will receive a confirmation email from a staff member as well as instructions on how to pay the registration fee. 
    
    Please note: We are currently in the process of improving our permit process. We hope to have an online payment option available to residents soon. Thank you for your patience! 

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69. 1. Receive an email copy of this form.
70. Email address

    This field is not part of the form submission.

71. Submit

* indicates a required field