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Mobile food vendor - licence application

By-law number 2011-06-029, as amended by By-law 2012-04-020

Business Owner's Name

Business Owner's Mailing Address

Email Address

Phone Number

Name of Business

Type of Business

Please list the food items to be sold.

Please provide the location of where the mobile food vendor will be located

Please provide the names of all registered property owners at the proposed location

Pursuant to Section 9.7 if operating from a private property, written permission from all of the registered owner(s) or authorized agents with proof of signing authority from the registered owners of the property must be submitted.

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The undersigned hereby releases the Corporation of the Township of Laurentian Valley from any or all claims for damages which may arise while operating within the municipality under which the undersigned is licenced by the municipality to do so.

I agree

I hereby certify that the information contained herein is true and correct. Please sign within the signature box.

Clear

Signed on this date

Personal information collected in this form is collected pursuant to Section 151, Municipal Act S.O 2001, c.25, as amended, and will be used for the purpose of processing your application.

Questions about this collection should be directed to the Township of Laurentian Valley:

460 Witt Road, Pembroke ON K8A 6W5
Attn: Claus Trost
613-735-6291 x210

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Mobile food vendor - licence application

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