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Mobile Restroom agreement application

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Please correct the field(s) marked in red below:

All applications, including those submitted via an online form, must be signed and dated by the restroom owner/agent and the mobile/vendor owner/operator before it will be processed. To sign an application, visit the Health Services Department on the second floor of City Hall,  72 W. College Ave. Offices are open from 8 a.m.-noon and from 1 p.m.-5 p.m. Mondays-Fridays. For more information, call 325-657-4493.

The mobile food establishment owner/operation must ensure that approved toilet facilities are available to employees. The restroom must be readily accessible within 100 feet of the mobile food service during all times of operation and if at any one location for more than one hour.

The restroom must be provided with adequate hand-washing facilities and be fully plumbed to city water and sewer (or an approved septic system). Port-a-Potty units are not allowed. Adequate hot and cold running water must be available. Thorough documentation of restroom accessibility is necessary for permit approval. Provide documentation noting the route and exact location of the restroom. Indicate how many feet it is from the mobile food unit to the restroom. Restroom keys must be provided for employee use of the restroom if the business hours of the food service are different from the business with the restroom. (ALL these items must be addressed and documented.)

1

Mark which of the following are available at the restroom location:

Mark which of the following are available at the restroom location:
2

Distance, in feet, from food service to restroom: 

 *
3

Food service hours of operation: 

 *
4

Restroom accessibility information: 

 *
Restroom accessibility information:
5

Mobile unit/vendor information: 

 *
Mobile unit/vendor information:

This agreement between the owner/agent of the restroom and the owner/vendor of the mobile food unit operation signifies that both parties agree to the allowed use of the restroom facilities as specified. 

Note that this agreement is non-transferable. Should there be a change in ownership of either the restroom or mobile food unit owners, or should there be any modification or cancellation of this agreement between parties, then the Environmental Health Division’s Food Service permit may suspended.

All applications, including those submitted via an online form, must be signed and dated by the restroom owner/agent and the mobile/vendor owner/operator before it will be processed. To sign an application, visit the Health Services Department on the second floor of City Hall,  72 W. College Ave. Offices are open from 8 a.m.-noon and from 1 p.m.-5 p.m. Mondays-Fridays. For more information, call 325-657-4493.

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