Mobile Unit Application

Department of Health · St. Joseph County, Indiana

Editable official PDF

Edit the agency’s original form, save your draft, attach documents, and review your completed PDF before signing or ordering delivery.

Print and mail service is available for your prepared packet. Review the destination and the agency’s acceptance requirements before ordering. Government payment is separate from document and postage charges.

Applicant fields are mapped to the source PDF. Agency-only fields are reserved.

Official form and instructions Pay the agency directly

Your application steps6 steps · Department of HealthView steps

1Prepare your answersComplete here
Edit and save your answers on the official PDF.
Official source
2Add supporting documentsComplete here
Attach the supporting records listed by the agency. Check that every page is legible and complete.
- Schedule an opening inspection for all mobile units and food delivery vehicles for the current year.
- Include route sheets, dates and locations.
3Review and signPrepare here, finish outside
Complete each applicable applicant signature after reviewing the full declarations. Required notary, professional and witness signatures remain separate.
4Choose paymentPrepare here, finish outside
Current schedule: $100/unit for prepackaged mobile food or seasonal pushcarts; $200/unit for dispensing or food preparation in the unit. The older form prints a blanket $100 rate; use the current agency schedule and confirm the total. Government fees are separate from the optional prepared PDF and postage. Review the exact amount and recipient before authorizing a check.
Pay the agency directly
5Submit or order deliveryPrepare here, finish outside
Schedule an opening inspection for all mobile units and food delivery vehicles for the current year. Include route sheets, dates and locations. The original PDF is available to prepare the application. The official payment form instructs users to submit their application through DocuSign first. For a paper/PDF filing, coordinate payment with the department before using that payment-only page.
Official submission instructions
6Keep your receiptComplete here
Save your agency confirmation and payment receipt. Track any mailing from My applications. Delivery does not mean the agency approved your application.

Official requirements and sources

Mobile Unit Application
Exact original PDF, applicant fields, signature blocks and printed instructions reviewed.
Official fee schedule and accepted payments
Expressly verifies check payee, mail instruments and processing charges; does not accept personal checks.
Current department fee schedule
Current schedule: $100/unit for prepackaged mobile food or seasonal pushcarts; $200/unit for dispensing or food preparation in the unit. The older form prints a blanket $100 rate; use the current agency schedule and confirm the total.
Environmental Health current contact
Current page gives 8th Floor and mailto:envirohd@sjcindiana.gov; public phone 574-235-9750 option 6.
Department contact page
County-City Building 8th and 9th Floors, 227 West Jefferson Boulevard, South Bend IN 46601; Mishawaka office closed June 20, 2025.
Official payment-only form
Instructs payment after the DocuSign application; this page is not a substitute for submitting the application.

Complete your application

Required fields are marked *. Fields follow the agency’s published form. Save your work before leaving this page.

Fill in the official form

Select a highlighted blank and type directly. Use Field list for larger controls and any answers that need a continuation page.

Page Zoom

Find a field

Page 1 of 2 · 33 editable blanks

SJCHD 04-300-A Revised 11/7/2022 St. Joseph County Department of Health Permit Application for Mobile Units Company/Mobile Name: Application Date: Address: City: State: Zip: Phone: ( Contact Person: Email: Print Name: Signature: Please see fee schedule on reverse side of the application. Fees are not accepted after 4:00 p.m. Our office shall accept Business Checks, money orders, cashiers’ checks, Visa/Master Card, and Cash. Please place additional information on the reverse side of the application. All mobile units and food delivery vehicles must schedule an opening inspection for the current year. License Plate No. of each Mobile units must include route sheets, dates, Make and Model of Vehicle vehicles if applicable and locations. For Office Use Only! Date Paid: Opening inspection date: Total Amount Paid: $ Permit(s) received on: Additional Information Transaction #: Department Employee: Informed Mobile/Pushcart Vendor of South Bend License 1

Select any highlighted blank to type. A larger copy of the selected question appears here.

Review every page before signing. Professional, agency and notary signature areas stay reserved.Original blank form

Before you begin

Application checklist

Schedule an opening inspection for all mobile units and food delivery vehicles for the current year.
Include route sheets, dates and locations.

Published government feesCurrent schedule: $100/unit for prepackaged mobile food or seasonal pushcarts; $200/unit for dispensing or food preparation in the unit. The older form prints a blanket $100 rate; use the current agency schedule and confirm the total.

Current schedule: $100/unit for prepackaged mobile food or seasonal pushcarts; $200/unit for dispensing or food preparation in the unit. The older form prints a blanket $100 rate; use the current agency schedule and confirm the total.

Current fee schedule lists $3/item mailing convenience fee and card processing fee of 2.55% or $1.55, whichever is greater; electronic checks $2 below $50,000. Confirm actual extras and applicable late charges with the office.

The linked legacy form is revised November 7, 2022 and prints a Resolution R-18-C-2015 fee schedule. Confirm the current fee and whether the newer mobile-establishment packet is required.

Fees are not accepted after 4 p.m. The printed form accepts business checks, money orders, cashier checks, Visa/MasterCard and cash.

Current Environmental Health contact is envirohd@sjcindiana.gov; older .com addresses remain visible on some original PDFs. Confirm mailing floor before posting a packet.

Current 2026 fee schedule distinguishes $100 prepackaged units from $200 units that dispense or prepare food; the original legacy PDF is retained unchanged.

Official requirements Official source form

Source version: 2026-10-05.regional-1

Your work stays yours

Application answers and files are encrypted in private storage. Authorized service managers can review signing history and documents to process your request.