HomeMy WebLinkAboutBayou Billy PERMIT 730920 10 09 15.JH.PDFTime In: 1 0 ' 5 4 El ant Time Out• 1 0 ' 5 5 5 are l Ti t Toarne� 1 minuts
Cl pm E1,PM [ENew [:]Transitional
B A Y 0 U B I L L Y
Name of Establishment
P 0 B 0 X D I
Address 1:
Aociress, z:;
C H I M N E Y R 0 C K N C .1 8, 7 .1 0
City z _,P
B A Y 0 U B I L L Y
Permittee
M ailing Address 2
C H I M N E Y R 0 C K N C 8 7 � 0
City: Slate: ZIP:
Phone Fax Emergency Phone Number
Ematil Address:
5-5 - MunicipallCommunity 4-4 - On Situ System
Water Supply Wastewater System
0 9 a 0 4JjM Eintev i4lSt 4 CigitS orfly
Facility 11) Old F acitity V
M ap 9 Parcel ID #
#
NIA 01
Risk Category Territory ii! Capacity:
73 - Temporary
Operate a: Status cocre
1 0 / 01 9 / .1 0 1 5
Lat, Long. Date.,
E —US—h-9 art 0 _rM F U E]Pushcart []MFU
Pushcart/fAcrofle Food Unit operating in conjunction with, Restaurart for ClammissaryID:
Transitional Permit Conditions. Permit Expires: 0 days L] 180 days
Conditionsi'Remarks N�)n-Rgplisint Items completed by:
OPERATE THROUGH 101115
Non -Compliant Remarks
$R4,10,
I
Establishment Assigned To;
11554-Huffman, Jason
M anagerlPerson in charge
1 0 0 9 0 1 5
Title Date:
im
M
M
ING Department of Health and Human Services
Division of Puhhc Health
Environmental Health Section
OPermit [—]Transitional Permit
Date: 10109 2ol
Name of Establishment: BAYOUBILLY Permittee_BAYOU BILLY
Location Address: a BOX 22
Gityt HI t�lit 'Y O K
tate: NC Zip 28720 Manager/Poison in Charge'-
Billing Name- BAYOU BILLY County, Catawba
Biting Address:: PCB BM 22
City:: HININ "Y ROCK
State NG Zip: 2 720
KRIlVT4WM
Email Address: Establishment ID 2018730 20
---------------------------
Phon Pax, Map #- _----------- --. Parcell D---------------
Emergency Phone Number L,at---------------- Long:...............
Permission is granted to operate o 13 - rernporarry Food Establishment as d flneud in G._ 12tt-247(1) and 1 °BOA-248•,
I' egul tion of Food and Lodging Facilities. Seepiermrequirements in Pules, This permit is not transferable and may be revoked for fail+ure to
comply with all requrements-
Wasteywater ysterns.° rlunicipaXornmunity [Eon -Site System Capacity;
Watersupply: Gi u icipaVommunity On-®- +te Sy,stem
FusricartlMolefle FODO Unit operating in conjunction with;:
Goo itlonaIRernatrs:
Estartlishrnant assigned to: 1654-Huffman, Jason
OPERATE THROUGH 10111
ategcry
-----------------
Restaurant or Cornrn+ssary warn�e anC! ll� number
Attachments
TranSitonalPiartrtitC ndition
Th+ p rrrrt h ll 4 r+r fin; pod + not r r vie All npn,r rnplipnt+t rtra I $titt h r rn �n tt � peg e (lt
apphcahsle(crust be completed within 9tr � 180 dais days This estatrl shrnent roust close if all n.ancornpl ant items are not Corrected by the
expiration date,
Received By; Title; Crate: 1WO9/201
M anagen'Person in Charge
algined By: REHG #. 1 r54-Htctf air, Jason L?at€: 1Cl00`2Gi1E
Di H al th
Piarprase: er al statute f . 24 l`, s tes stablis t shelf co e�r ar oorit rue opera[ cn aNithc+ut a nit or tmnsi donal permit i:ssueid bay the Depar at,
I le tt ter Iran tionai it Shull issu to trice or operator of €ire establis tit and shall not be ttansfen-ble If th esta ii rent is lea d, the t err-
trar sr ttonal t shall be issue,& to tht es and ,a t tot bt, transferable. If die ltacatton of an estab4i sett cfiarr gas, a neat• perrntt shal l be +obtained fat• the
establishment rd pennit shall be issued onl- ixtien the estabh_ erst satisfies all of the requim, vents of the nags The Commission shad adoptrules establisiung the
ferquinm,tmls that, trust bemetbefcre, a trar ismmal perrat maybe issued, and the penod forTIaich a transitional pemitmay be i s sawed. The Erepiftment nmv al so in pose
conditions on thic i gsuance of a permt or trans tionaL p=itin ac eordance with rulesadopted by, the Cornrni ssi A pcmt artransitional pernnit shall irnan ate1y=
rra-cstced in ac�ordatxce ras:tbi 5 1 �d31L � �{dg far fait ore �f she: ease tali stsrn�r-it ro rnai�ieairt a r�iazurr, ale of � :t t �°atxsiri aasat t rna�+ad°ervat isC
su - dad or re,vzked sn accordance i4�ith l 3Gi 2d Preparattotr Local enaimmnental health specialists, shall issue a p=it every, hone a change in pen, rut status is
indicated_ Prepare an cr-riginalmd one copy, for f OdEinal to be left svftli the owner oroperator- ? Copy, for the lacat tieatthdeprartment aspositian Please refer to
Rccor&Retentim and Erispossttmt Sditdule 'B.Gr., for County Distinct Health EkepartntmtsNvhich is published bythe North Carolina Division cpf. Archiv°es : History.
Add.itiomaf farms rnav be ardeied frorxr Eraaronaneneal.Fiealttr Siecteaai, 1 fr32 1Fa l ``era ce Cartes, eaghm �tiC f 44 tf fib, [CaLzrier g f l 4Gt
EHS 1Al (revised 07912)
Environmental Health Section
Comment Addendulm - Attachment
Establishment Name- YOU BILLY
Establishment JD- 2018730920
Lo,cationAddress.- POBOAC 22
CRY: CHIMNEYROCK State: NC
C,oUntyatawba Zip :, 2ST20
Wastewater System: c-) rMundp@VC&mmur,,i,ty (9 On -sits System
Water Supply: a 0 cm- ajtv syltem
Permittee: BAYOU BiLLY
W29M
ConditionslRernaMs (continued):
Nan -Conn pliant lterns:
Status code � Jim
Cat,egory 4�: —