HomeMy WebLinkAboutFLI-08-2022-177729.tif Application for Temporary Food Establishment Permit
(To be completed for each booth)
c a t a w b a count $75 roe applies I Please make checks payable to Catawba Cooary Environmental Health
y Mail to:Catawba County Environmental Health,PO Sox 389,Newton,NC 28638
public health
MAKING. LINING. tfillt. "All parts of this application must be filled out before turning in"
Ft/"Ot 1771X
Eslaihim at Name /lie CL Gr,'//
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Nahum Address 13 4l o01/
Tebpbeao(daytime) 70cl" .3 (owning) ?i y 5-30 —/6?/
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Now a Ev. t/f.sfw!/Carslra;.k. li L16 l`y /17 f 1ICA 4 1-€ 04 F' r
Data i lbws of Operates 4 , 3/ S 7d 541"
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Event Locales IA .ecrca n i e ,o A ,4v . sop Co spletfoa Dare a no. Au?, 30 n i 3: ooPfri
Stamen of applicant
Aleot: Mock nearer d food has to k pnpand or served
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All foods sold at Nils Twopenny Food Establishmeat wow he prepared tad cook d at fie p rwitr.d site wept foods prepared Is aaetier
esttblsiawat permitted fader ISA NCAC 11A.2659.
Food Prepared and Cooked On-Site: Is tie toile below, chock do prondans for each food width wN p&Yag V E D
is fie Temporary Food Establishment.
AUG 1 2 2022
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Foods Rik
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Foods Prepared and Cooked Offsite:
Name of Permitted Establishment
NC DENR Establishment WD# (1---
Establishment Owner/Manager
Establishment Address
Establishment telephone#
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In thp table below list all foods prepared in the .• •blish"nt And check all procedures performed there.
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Method of storing and disposing of wastewater:
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Booth sketch:
Draw the food berth, identifying and describing all equipment, including hondwashing fodlities, equipment washing
fodlities, cool*egoipmeot, refrigeration, worktables, storage, bet and cold bolding units,water source and storage.
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U4'A • CATAWBA COUNTY
Q" 100A SOUTHWEST BLVD
14 NEWTON,NOR L I I CAROLINA 28658 RECEIPT
PHONE:I ON I;: 828,4 65.83 99
U Monday,August 15, 2022
I$42 sM www.catawbacountync.gov
PAYOR: Little Red Grill LLC
Little Red Grill LLC(Green,Angel)
PAYMENTS
TRANSACTION NUMBER: TRC-453391 17-15-08-2022
PAYMENT DATE: 08/15/2022
PAYMENT TYPE: Check 1557
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
08-22-410535 110-580200-663000 Temporary Food Establishment $75.00
Fee
TOTAL PAYMENTS: $75.00
FLI-08-2022-177729
CASE TYPE: Food&Lodging Institutions WORK CLASS: 73-Temporary Food Establishmen
SITE ADDRESS: 1127 US 70 HWY,NEWTON NC 28658
Applicant LITTLE RED GRILL LLC, 1308 ALF HOOVER RD,VALE NC 28168
C:7045301681 CARTERZOEY6239@GMAIL.COM
**NO PEOPLESOFT ACCOUNT ASSIGNED"
receipt 08/15/2022 09:53 Page 1 or l