660 Mayport Road - moblie food vending applicationt--;, MOBILE FOOD VENDING APPLICATION FOR INTERNAL OFFICE USE ONLY
City of Atlantic Beach FILE #
r )� Community Development Department
800 Seminole Road Atlantic Beach, FL 32233
(P) 904-247-5800
APPLICANT INFORMATION /� taVj
NAME _T1� Wt� lL
(+0 CELL # 30q F0 f 9
ADDRESS ZT (o7H ST/2G-rL`TT PHONE # C(O 8
CITY STATE -f''(,,. ZIP CODEZ7.-Z�, EMAIL
RE# j:J-0 3-q!57 - 0/00 BLOCK # 31
LOT #
LOCATION OF MOBILE FOOD VENDING (Non -Residential districts only)
1- Qo if ;MCI _ A*c i/ L
DURATION AND TIME OF MOBILE FOOD VENDING A -IQ JV,�A)-V — / e_tV'4y
Applicants shall adhere to Section 24-154(3) and Section 24-17 of the City of Atlantic Beach Code of Ordinances, Zoning and Subdivision TjU15tionsl
Mobile Food Vending Units are defined as a public food service establishment that is either self-propelled or otherwise movable from place to place
which is properly licensed and operated in accordance with state regulations. A mobile food vending unit must have, as part of the unit, a three -
compartment sink for washing, rinsing and sanitizing equipment and utensils; a separate hand wash sink; adequate refrigeration and storage capacity;
full provision of power utilities including electrical, LP -gas, or portable power generation unit; a potable water holding tank; and a means for liquid
waste containment and disposal.
PROVIDE ALL OF THE FOLLOWING INFORMATION
(all information must be provided before an application is scheduled for any public hearing):
1. Site Plan showing the location of all structures (temporary and permanent), including setbacks, square footage, parking spaces,
fire hydrant locations and existing and/or proposed driveways. Proposed location of mobile food vending unit(s). (Attach as
Exhibit A)
2. Proof of ownership: deed or certificate by lawyer or abstract or title company that verifies record owner as above.
3. If the applicant is not the owner: provide a letter of authorization from the owner(s) for applicant to represent the owner(s) for all
purposes related to this application.
4. Survey and legal description of property sought (Attach as Exhibit B).
5. Required number of copies: two (2) copies of all documents that are not larger than 11x17 inches in size, if plans, photographs or
colored attachments are submitted.
1 HEREBY CERTIFY THAT ALL INFORMATION PROVIDED IS CORRECT AND THE MOBILE FOOD VENDING IS CONSISTANT WITH
THE DEFINITION OF THE ODE (SECTTON): Signature of Property Owner(s) or Authorized Agent
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SIGN UR OF APPL CANT PRINT OR TYPE NAME DATE
Signed and sworn before me on this day of ` ti �� -by
Identification verified:
Oath Sworn: E] Yes ❑
SP?CPQ'••. TONI GINDLESPERGER
MY COMMISSION # GG 353178
EXPIRES: October 6, 2023
28 MOBILE FOOD VENDING APP 10. Bonded 7hru Notary Public Underwriters
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Notary Signature
My Commission expires
State of U
County of C__ -)C) V, Q -