HomeMy WebLinkAboutEHPR-5-11-11063.TIF � }.
�A��� ' r Catavvba County E�vironn�ental I�[ealth
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t;� � �, Contact Information for Plan Review
�t.� �°�:� � 100A Southwest Boulevard, Newton, NC 28658 `
� � 2 - (828) 465-8270 phone (828) 465-8276 fax / I��� '�,,) f - I � ��3
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FLI Case #
. PLN Case#
Property Location
Property ID# * - - -
Street Address * D� �? � —� ��i'�'1 / �S �
City * � � 32% /V .
z�p * v
Business N��e: * � � ` �G��i°I'z G� ��rt'7 i
Mailirlg Address T D/�D "12 lY� G�� �
Address 2 *
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Zip T � d� D'�
Phone * 8� 3Z7-� !o
Qwner Na�e �C - l�t CG s� � Y
Owner Mailing Address � ,�t�X .311 /2
Address2
Ci�ty
Zip � �'Z � -ll3t� trct'/
r��ne � � �
Architect N ��"
Contact Address �
Address 2
City
Zip
Phone .
Contractor N��}
Conta.ct Address
Address 2
Cl �
Zip
Phone �
Contact Information Sheet and $200 fee required to be�in plan review process
Complete and return Food Estab 'shment Application * Required. field
Applicant Si�ature Date �� l�
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E,r � Catawba County Public Health Department
� � � Division of Environmental Health
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FOOD ESTABLISHMENT PLAN REVIEW APPLICATION
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Type of Construction: NEW REMODEL CONVERSION /�
County in which Located: �C " (il/��
Name ofEstablishment: �5 .'�� � �' �Y ��-
Establishment's Address: �� / � � � �
City: ' � ' � Zip Code: �.. jO�o2.
Owner's Current Physical /�� �-,,.� �7
Mailing Address: City: (� /�C �- Zip Code:
Phone if available: (�, — 2 - �) Fax: �( Z-C� ) — (,j27 - -j7�� >
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I have submitted plans/application to the following:
(Plense note date plzone mrmber and contact person on applicntion line)
Plumbing
N I� Contact Person
, ; �,(,,S Phone Number (_� — (_ - �
�t
c `� D Electrical
R L
�,�,V ontact Person
Phone Number (_� — � - _)
Building
Contact Person
Phone Number (!� — �_ - _) �
Hours of Op ation �� i „ fy -.
Sun Mon � � Tue Wed Thu Fri VY) Sat
Number of Seats � �
Number of Staff � (Maximum per shift)
Facility Total Sq. Ft. � ��� Z�
Projected Number of Meals to be Served: (Approximate number) 07 �
Breakfast �� Lunch j�� Dinner�
Projected Start Date of Construction N/,,�'
Projected Completion Date of Project
1
6" �
Type of Service (Check all that applies)
Sit Down Meals I (`�_7'z�-r�'YC � ✓
Take Out
Caterer ✓
Mobile Food Unit
Push Cart
Limited Food Service
Temporary Food Stand
Single Service Utensil Only
Multi-Use Utensil Service Only �
Both Multi-Use and Single Service Utensils
Other
Please Enclose the Following Documents
� Proposed menu items (including seasonal variations in the menu).
m 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 any outside facility (dumpster, walk-ins, etc.).
� Plan of facility drawn to scale showing location of equipment, plumbing, electrical service and
mechanical ventilation, including location of all electrical panels.
2
.�� �o CATAWBA COUNTY Nc
�� '{� �� 100-A South West Blvd PL�4N RECEIPT
� ' � �-] Newton, NC 28658-
U '�� o �' (828)465-8399 Tuesda Ma 31 2011
�� Y� Y ,
1842 sM www.catawbacountync.gov
P�an case: EHPR-5-1 1-1 1 063 �nvoice Number: INV-5-11-275843
Environmental Health Plan Review Invoice Date: 05/31/2011
Site Address: g00 SE 17TH AV DR, Hickory, NC
APPLICANT OWNER CONTRACTOR
LIAZZO'S CATERING AT CORNING
800 NW 17TH ST
HICKORY NC 28602-
(828)244-6365
Fee Name Fee Amount
Food and Lodging Review Fee Fixed $200.00
Total Fees Due: $200.00
PAYMENTS
PAYER: JESSICA FRYER
Date Pay Type Check Number Amount Paid Change
05/31/2011 Credit Card -1 $200.00 $0.00
Total Paid: $200.00
Total Due: $0.00
plan receipt 0�/31/20l I 08:19