HomeMy WebLinkAboutEHPR-11-2022-42763 G) ENVIRONMENTAL HEALTH
Catawba County Government Center
25 Government Drive I P.O. Box 389 I Newton, NC 28658
Catawba county Phone: (828) 465-8270 + Fax: (828) 465.8276
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Food Establishment Plan Review Application
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Type of Construction: New ❑ Remodel ❑ �"
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Name of Establishment: 6 q L Y ,„�2- LI t f1 >"
If existing, please give name of old establishment if known:
Address: //a r 1�.4s, Ur �+'� • .'^
City: H fee �042'y State: NC ZIP Code: -- --f�'U v�
Phone(if available): ,% - ,7 "/2 1/ Fax(if available): `-- '" •�'�' i1j(jS
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Owner or Owner's Representative: j �T r�~�
Address: ,/.:2 c 13 i't- /-Fu ,, � 5 -
City: �7e/z c �'7' State: NC ZIP Code: t.S '
Phone (if available): _3 . - ''C5'$' ' Fax (if available):
Email Address: N4L/ /4f P 1 i z'-L �-c c4.� /fi 'H'(.. �E_ ,s
Submitter: AP/ 1
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Company: ,Yt 1� o �J �Z6 n c �' 't`.
Contact Person: N/ < �L-
Address: // '2 i. 1 � i'J E
City:
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without 4s • 3 , tttliMffic y nullify plan approval.
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Hours of Operation
�%' J > IOn ' Tue / Wed /�-4C Thu � - ' Fri'' I Sat L
Sun ! �
Projected number of meals served between product deliveries:Breakfast �"" Lunch Dinner
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Number of Seats: J<7" Facility total square feet:
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Projected construction start date: `:16 Il 1`1 Projected construction completion date:
I'•; -:- oi r.,;, ::''p l •1.: (check all that apply)
❑Restaurant 0 Catering Single-service (disposable): 'ffhates tia6lassware Silverware
❑Food stand 0 Sit-down meals
❑Drink stand ❑Take-out meals Multi-use (reusable): 0 Plates 0 Glassware 0 Silverware
❑Commissary 0 Meat market
Other(explain)
peciatized Process,2s
Please indicate if any specialized processes will be used.
❑Curing 0 Acidification (sushi, etc.) ❑Reduced oxygen packaging(vacuum seal)
❑Smoking ❑Sprouting beans ❑Other
Explain checked processes: /U/i?
Populations Served
Indicate any of the following highly susceptible populations that will be catered to or served:
❑Nursing home ❑Child care center ❑School with pre-school aged children
❑Assisted living center ❑Health care facility
Please Enclose the Following Documents:
• Proposed menu items(including seasonal variations in the menu).
• Manufacturer specification sheets for each piece"of equipment shown on plans.
• Site plan showing location of business in building,location of building on site including alleys,
streets and location of �tsi.e;fadil ty(dtimpster,walk-ins,`etc.).
• Plan of facility diawn; Bale aN nghloc t n o ;equi ent,plumbing, electrical service and
mechanical ventil tt' idia• o°eaon�ofl "► ,, e(s
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.44'A • CATAWBA COUNTY
��' I00A SOUTHWEST BLVD
` NEWTON,NORTH CAROLINA 28658 RECEIPT
PHONE:828.465.8399
Monday,November 14,2022
18 4 sm sM www.catawbacountync.gov
PAYOR:
Patel,Navin M
PAYMENTS
TRANSACTION NUMBER: TRC-5 1 1 86043-1 4-1 1-2022
PAYMENT DATE: 11/14/2022
PAYMENT TYPE: Credit Card
297475278
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
11-22-414738 110-580200-663000 Food and Lodging Review Fee $250.00
TOTAL PAYMENTS: $250.00
EHPR-11-2022-42763
CASE TYPE: Environmental I Icalth Plan Review WORK CLASS: Other FLI
SITE ADDRESS: 1125 13TH AVE DR SE,HICKORY NC 28602
Applicant QUALITY SUITES, 1125 13T11 AVE DR SE,HICKORY NC 28602
Paid By NAVIN M PATEL,4622 VILLAGE SQUARE CT,GREENSBORO NC 27409
**NO PEOILESOFT ACCOUNT ASSIGNED**
receipt 11/14/2022 15:06 Page 1 of I