HomeMy WebLinkAboutBentlee's Permit 011338 11 13 14.sc.pdfAddress 2:
H i c k o r y N C a 8 6 G 1
City: state; ZIP:
I to h n F r i t z q e r a I d M i c h a u x
Permittee
T o s h R i d d I e
Manager or Person in charge
[E 14 ailing Address Same
T o h n F r i t z g e r a I d M i c h a u x
M ailing N a me
1 8 a 5 N C e n t e r S t
M ailing A ddre as 1
H i c k o r y N C .1 8 6 0 1
City: State: ZIP:
8 J 8 8 5 5- 1 9 1 6 8 a 8 3 0 ' .7 7 9 1 3
Phone Fax Emergency Phone Number
jdd44@gmaii.com
Email Address:
5-5 - MunicipallCommunity
NEMM=
1 3 3 9 40&Enterlast4di9ftxonly;
Facility ID
1 8 Catawba
CoMy #
3®3 - Muni cipat/Community IV
Wastewater System Risk Category
1 - Restaurant
OtdFacilfty ID: operate a:
01 1 6 0
Territory # capacity.
I
Status Code
M ap, # Parcel 0 #
1 1 / 1 3 0 1 4
Lai. Long, Date:
Posit Cart orMIFU []Pushcart E] M Five
Pushcarlitylobile Food Unit operating in conjunction with Restaurant or CommissarVID.,
E-]If
Transitional Permit Conditions: Permit Expires: Non-CF_Jqoday's ompliant items co180days
mpleted by;
Conditio& n'R emarks
C�Iara';*'O
4000
Non -Compliant Remarks C)rk the Chec*I)OK 10 add non_comp�anr remarks
EHS ign ture:
1711 -Carpenter, Scott 1 1 / 1 3 / 2 0 1 4
EHSIO Date:
/ ioew&
M anagerk'Person in charge
1 1 1 1 3 0 1 4
Title Date:
M,
NG Departrrlerlt of Health and Human Services [j]Parrnit F-]TransitionalPernnit
D iv ision of Public I I ealth
Environmental Hoalth Soction Date: V1112014
Name of Establishment: BentLee's Permittee:John FritzgeraA Michaux
Cly: Hickory
Stato - NC Zip: 28601 rJanagiar/Piorson in Gnargo: Josh Riddle
Milling Name John Fritz 9orold Kchaux County- Catawba
BfilngAddress 182514Cashlar St
city, Hickory State:,NC Zip: 28601 Status code: I
Erriall Address: jdd44&;imail.mno Establishment ID, 2018,011339
---------------------------
Phone- 182,8) 855-1916 Fax: MaP #� - — — — — — — — — — — — — — — - Parcel ID -- — — — — — — — — — — — -
Emergency Phone Number (828) 3,02-7913 Lat . . . . . . . . . . . . . . . . . Ln, n . . . . . . . . . . . . . . . .
Permission is granted to operate a I - Restaurant asdefined inGS 131 -,247(l) and 1 MA-248,
Regulation of Foal and Lodging Facilities. See permit requirements in Rules. This permit is not, transferaole and May be revoked for failuria to
comply wth all requiements,
WastexeaterSysterns; glfouricovcmrrlunk, []on -site System capacty: 160 categorr ID E 21
Water Supply: [flM uricipallr-)mmunity [:]On -Site System Ifl RI
Pushc3rt'Nobile Food Unit ope'ating in conjunvion with 8 e STU r8rit Or COMM SSa'V Name an 0—iUr5aT — — — — — — — — — —
Cc nd it! on &Rem a rk&
Ectablishrrent assigned to1711-Gorponter, Soon:
- ----- - ---------- ---
$i tion a I Penrn it Conditionm;
-his permit $hall expire 01 and is not renewa4le, All ri�n-comrlian, items lWed herein and on attached Dages of
anali--ablP0 must ce cDmic.leteJwilhn go / [:]180 (lays days. This astablishrnent mist close if all noncornaliant i,.ems are not corrected lce the
expiration da:e.
RP,rP.lvPd RY L&A, Tit P,
tt analgeriPerson in Charge
nAte., 11113rz.014
C- _/ --) Sioned BY: � �_ =�J"� , REHS#: 1711-Carmenter, Date: 1111312014
ision oPublic Af ealth
Purpwe; General Statute 130ek 218 (b% stat5s "No establiahmnt all --crarnetice orcorrinur-operation Nmthout a permit of ptmit ismed by the Depirurmmt_
'Me it or transitional perrnit -!all be- issued to flit cixner or ator of the establi s1mriat and shall trot be tranffemblt,_ If the establishment is 1,cate, the p=t or
transitonal ptmt shaH be issued to the lessee. and shall not be transkrabIt,. If he locaoan of an establishment rhuges, a nevvpurnif shall be obtained for the
establishnitrit- A pertnit shall he issued on1jrNiter. Ifteestablishrn.-rut satisfesall of the requirerrrentscf the rules- 71e Cornri-fissuan shad adopt rules est2blisbing the,
requirements diat must be met bef(re a transitional Pero tativ Ist, issued, arid the, penod fbT Much aim, ns.tional pennitmay he issued. The Eitpannent rnay also inipose
uclidituns U11 thr nmancr Ufa paruit ur ualisidunal pnriiiL in acLuidariLrNNiLL zults,adoptnd by ffir Cumurissiun- A purini, LYI Ilarnatiulia PtIrilit, -11all bn it-.1111o&aLd'v
t-e,cke,din,acr-ordance,mithG-S- 13,GA-23(d) for fhilureaf the establishment to maintaira tranitrurn grade of C_ A p, =il a trarsitiorral permu: may obienNise tie
suTerdtdo,rzcvokt.dinaccc,rdarce,NRithG-S- 130A-23--" P'repantiorrLocul en),iranarrental health specialists, shall issue, a perit every time a change in pennit status is
indi ca-red. Prepare anon paaal md one cop77 for I . On g �,cae, or operztcr. 2. Copy, far &.e Iacal heqlthdepirmint. Dispamncm: Please rekr to
gig to be left oath theo v
RtcoAs Retmtai and DI sTosition Schedule 8 B 6.. for °�ountyDli strict Health Depattr:eats whi:h is pub i stied by the, North Czolina Ids a sion of Archives & Histon.F
Additional forms rriav be ordm5d from: Fmiromneritai Healta Sector, 1632 Mail Sen"ice Center, Raleigt4 N7C 27N9-16329, (Courier 52-01-0,1,1
EH 3 1341 (revises, 07112)
Ery iron m enta] Health Section
Comment Addendum - Attachment
Location Address,: 1825NCent erSt
It: Mockery
County, Catawba
Wastewater System: (j) klunicipavCornmuniV C) n-Site System
Water Supply: @ C, 07-sits Sysksm
Permiltee: John FfltzgeraldMichaux
Condlllons/RemarKs icontlnueO):
Mon---orrpliait Items:
Date- 1111,W2014
Status Code: I
Cate gory 4., IV