HomeMy WebLinkAboutBayou Billy 731003 10 07 16.LS.PDFTime In, 0 9 : 5 1 El am Time Out: 1 0 : 0 0 0 a M TulalTirne, 9milnute3
El pm Opm NNew ETransitional
B A Y 0 U B I I L L Y
Name iolEstapl,shment
P 0 b 0 X d d
Address 1
C H I M N E Y R 0 C K
BA Y 0 U B I L L Y
Permittee
M anarger or Person in charge
E] ki ailing Address Same
.......... ..........
1A ailing Na me
N C a 8 7 a 0
3tate-. zlp:
1,A ailing Address 1
hl ailing Address 2
N
Qily g yy Stag; zlp;
Phone Fax Emergency Phone Number
r'—qt.qwh,q
Email Address:
5-5 - Municipal,Community
Water Supply
1 0 0 3 400 Ento laSt 4 digits only
Facility iD
3-3 - Municipal/Community N/A
Wastewater Systern Risk Category
Old F acioty ila
M ap Parcel ID #
. ....... . ...... . . ........
L at Long
Push CAA or MFU E]Pushcart EIM FU
1 8
County #
C 1
Territory 4 Capacity-
73 - Temporary I
operate a: 5fams code
1 0 0 7 1 � 0 1 6
.. ... ....... . .......
Date:
Push cartflA a bile Food Unit operatinq in conjunction with;
Restaurant or Commissary IV:
Transitional Permit Conditions: Permit Expires.,
0 days [] 180 days
ul�
------
Non
"'pliant items completed by:
ConOirlionsRernar�,s
4^119fAINV-1
4000
klon-Compliant Remarks
clxk sh�! chtckboIx t0 0d
maAs,
R in i rr M q
4000
Estatrishment Assigned To,
1896-Sears, Luke
EH 5 Signature,
hi anager/Person in charge
1896-Sean , Luke 1 0 / 0 7 2 0 1 6
1 0 / 0 7
0 1 6
EfISID Date:
Tile
Date:
NG Department of Health and Human Servlces [j]Perrnit TransitionalPermit
D iv ision of Public I I ealth
Environmental Hoalth Soction Date: 1010T2015
Name of Establishment: YOU BULLY P erm ittee: BAYOU BILLY
i
City: CHININEY ROCK
State .1 NC_ Zip: 287 20 rvianagcr/Pcr-,o,n in Chargio-,
Milling Name- County Gotawba
Biting Address_
C ity, State:,NC- Z ip,: —Status Code:
E m a 0 Add irt ss Establishment ID, 2018731003
Ph ne- Fax: Map #� - - - - - - - - - - - - - - - - Parcel ID -- - - - - - - - - - - - -
Emergency Phone Number. Lat ................ . Lon ................
Permission is granted to operate a 73 - rernporary Food Establishment as defined in G S 13,OA-,247(l) and 1 MA-248,
Regulation of Food and Lodging Facil Ities, See permit requirements in Rules. T his permit is not, tran steraole, and May be revolted for failuria to
comply wth all requi-ements,
WastexeaterSystern s: Rlkiuricovcmmunk, []on -site System Capacty:
categorf #: 91 E ff]
WaterSupply: [Efduricipal?Comrnunity E]On-Sits S;stem 11 IE
Pushc3rt'Nobile Food Unit ope-afing in conjunvion with Restaurant Or COMM SSa'y Name an —3—iUn3EJ — — — — — — — — — —
Ccndifion&Remark&
Ectablishrrent assigned 'to: 1806-Goaro, Luko
- ----- - ---------- ---
$i tion a I Penrn it Condithon%
-his permit $hall expire 01 and is not renewa4le, All nn-comrlian' items listed herein and on attached Gages (if
anali--ab,120 must be cDrnic.leteJwiflhln 90 /E] 180 dads days. This astablishment mist close if all noncornaliant '.ems are not corrected be the
expiration da:e.
Rp'reNpri Py Tit Pr
M 3nageriPerson in Charge
n,t,, 10,107r2016
Signed By. PEHS#: 1896-Setars„ Luke Date: _101IDTQ016
DVIS-lon of Public Health
Purpwe; General Statute 130A 248(bl%stat,3s "No tctablrnbrnt nt shall zom.menLe. orcontnueopeiation vuthouta pennutortransidotinl pemnitismed bythe Deparurmtnt_
'Me ptmitortransiBanat peinitt giallbe issued to rile curler or qperalor of the establisInrnt and 4iall not be 'Liransferable- Ifthtestabli_�hinent is leased, the perm or
transit or ptunit shall be, issued tothe lessee and lallnot be =skralolt. If ate location ofariestiblishmexit clianges, a neap pertrrushall beobtainedfortht,
establishrntrit- A pertnit&hallbe. issued onlvxviien tificestablistirnunt satisfies all of the reqiai=entscfthe rules - The Comrrfisauan span adopt rules est2blisfiing the
requirements dnatmust be met before a transitional pennt rniv, be issued, and the pet fiarwtiich a tran&tional perrrutmay beisstred. TIneErepartriew, mavalso impose
ucqldituri�'UTI ffiris-'aXanctufa pniniLui uankriunAl pninit ni accutdauLtvad. zuItsa&jpLtd by CuniTnissjuri- A ptnuft oi Uannaunal pninit 41all be iralliodiawtt�cked it1 accrirdatice �oitla + S f �t��,-��iili fgr failure •�f lisle establi=hrrietlt tti inairitair a rrmniiru pratle off: periuit , r�arsitictial permit ina�„ ct=aereni tie
suTerdeli o,rFoktditi,acc,erdarce,kiithG-S- BOA-23-2' P'reparadotr- Loml ern ,iro=tntal health srecialists shall issue p=,t ever-v, time .9 change in perrnit status is
indicated. Prepare an original and erne copy for I.Ongpnal L Cep-y for &.e local heqlthdepaitm-ant.I)%spasition: Please rekrto
RecoAs Retentai and Dispositiai S datdule 8 B .6_ for CountwDi strict Haalth Dep=nents, Anch is pubd died by theNoith Cwolina avi sicn ofArchives & Hmon.,:
Additional focus may be ord. from: Eniirozanentai Healm Sezfior., 16,32"NMail
EH3 1341 (reviseO 07112)
Ery iron m enta] Health Section
Comment Addendum - Attachment
Location Address,: Pry BOX22
City: CHIMNEY ROCK
County, Catawba Z ip: 28720
Wastewater System: (j) klunicipavCornnuniV C) On-Sita System
Water Supply: @ C, 'fin-sitL sysksm
Permiltee: BAYOU BILLY
was=
Condlllons/RemarKs ilcontlnue,3):
No n---orrplia it Items;
Date- iofo7,2o16
Status Code: I
Cate gory 4., 0