HomeMy WebLinkAboutFLI-08-2023-202546.tif PS
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' Application for Temporary Food Establishment Permit
(To be completed for each booth at least 2 weeks prior to the event)
$75 fee applies I Please make checks payable to Catawba County Environmental Health
cat a w b a county Mail to:Catawba County Environmental Health, PO Box 389, Newton, NC 28658
public health
MARINO. LIVING. BETTER. **All parts of this application must be filled out before turning in**
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Establishment Name If I - -11 y ig A0115); C) (Ara,' 1)- 001 `131, SC1
Operator/Owner Name -5!th 6 I 7 c o /l1,1 7 Oa ii r.
Mailing Address / 4.7Q''1 NU/fif IV c 1-I Li\-1 f ( ' (* di.eJ A) Cl ? b 6/.
Telephone(daytime) (J 2f3 .111).('66 Li 17 (evening) Mob - (I 2 - '7 y s 2.
E-mail Address: 4-day 0 1 '+c/136.- 0
Name of Event/Festival/Carnival;etc. /�/cg •'--7 AN c V Lam'an 1--es-/Uii FAI (0\141.Ell100E!f101
Dates & Times of Operation Ai 3 6 jJ ep, 047
Event Location JJ/t/4117 1;//6 J04,44 Setup Completion Date& Time A C: 2- / OO d
Signature of applicant m et Lit.n `J 014,7
Menu: Attach menu or list all food items to be prepared or served.
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 15A 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.
Foods k .� _ ._ .= o C
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