HomeMy WebLinkAboutFLI-04-2023-194090 G) Application for Temporary Food Establishment Permit
(To be completed for each booth at least 2 weeks prior to the event)
c at aw b a county $75 fee applies I Please make checks payable to Catawba County Env h,n-TingIVE D
Mail to:Catawba County Environmental Health, PO Box 389, Newt �i
public health
MAKING. LIVING. KETIEK. "All parts of this application must be filled out before turnino ht'*
-A 2 0 2023
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Establishment Name n '2 S I i)x l873 L�U(v Environmental Hoalth
Operator/Owner Name �o u S 4 r ix4 4 a i
Mailing Address d, 0 s- Z 'L /A /i at�C�•. 1' i 'e- .j7 V J
Telephone(daytime) 16 `1 99 i / 7 lc4, (evening)
E-mail Address: (le-'Q- & v I a-v t, c cn-ti--
Name of Event/Festival/Carnival;etc. /4d iL k 0 Al a .cam, i.,c-2-7—
Dates& Times of Operation 0 CA..i j 3 !X
Event Location 12V 'Y �A ' H ( �' "1 Setup Completion Date&Time 0 cr l /
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Signature of applicant
Menu: Attack menu or list all food items to be prepared or served.
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All foods sold at this Temporary Food Establishment must be prepared and cooked at the permitted site except foods prepared in another
establishment permitted under 1SA NCAC 18A.2659.
Food Prepared and Cooked On-Site: In the table below, check the procedures for each food which will performed on site
in the Temporary Food Establishment.
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��"�4'A CATAWBA COUNTY
� 100A SOUTHWEST BLVD
NEWTON,NORTH CAROLINA 28658 RECEIPT
111 O . PHONE:828.465.8399
Friday,April 21,2023
18 4 sM www.catawbacountync.gov
PAYOR: Steak Boys Inc
Steak Boys Inc(AINTRAZI,GUS)
PAYMENTS
TRANSACTION NUMBER: TRC-62353601-21-04-2023
PAYMENT DATE: 04/21/2023
PAYMENT TYPE: Check 3247
RECEIVED BY MAIL
INVOICE NUMBER ACCOUNT FEE NAME FEE AMOUNT
04-23-421524 110-580200-663000 Temporary Food Establishment $75.00
Fee
TOTAL PAYMENTS: $75.00
FLI-04-2023-1 94090
CASE TYPE: Food&Lodging Institutions WORK CLASS: 73-Temporary Food Establishmen
SITE ADDRESS: 280 UNION SQUARE,HICKORY NC 28601
Applicant STEAK BOYS INC,208 LAKELAND DR,MATTHEWS NC 28104-
B:7048823242C:(704)998-1796
**NO PEOPLESOFT ACCOUNT ASSIGNED**
receipt 04/21/2023 10:31 Page 1 of 1