HomeMy WebLinkAbout150 Grill Permit 011210 01 20 12 SC.pdfTime In 0 1 : 4 2
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Name ofEstabtishment
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w y
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Address:
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city;
State: zip:
P a t r i c
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Permittee
P a t r i c
i a
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y a
M anager or Person in charge
[E Mailing Address Same
P a t r i c
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M ailing Name
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Mailing Address
T e r r e t t N C
cfty; state:
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Phone Fax
Email Address:
6-6 - On - Site Supply
EMMM=
a 8 6 8 a
Zip:
7 0 4 3 0 9- 3 8 4 6
Emergency Phone h Irnbll
1 8 C atawba
�_.unty _#
4-4 - On -Site System IV 01
Wastewater System Risk Category Territory #
2 0 1 8 0 1 1 2 1 0 2 0 1 8 0 1 1 0 9 0 1 -Restaurant
Facility ID [:]Existing Facility" Old Facility ID: Operate a�
FIAItachments
Map # Parcel ID #
3 8
Capacity:
kill
0 1 1 a 0 0 1 1
Lat. Long. Date:
Push Cart or MFU [:]Pushcart E]MFU
PushcartlMobile Food Unit operating in conjunction with:
T
790 days [E 180 days ransitional Permit Conditions: Permit Expires: 0 7 / 1 8 / a 0 1 a Non -Compliant items completed 4y:
CondillonsfRemarks
NEED TO FINISH WITH CHANGING OUT CEILING TILES IN KITCHEN (11 TILE) AND IN ROOM WITH WALK-IN COOLER AND
MIDDLE PREP ROOM
Establishment Assigned To:
1711 -Carpenter, Scott
EH'signature' M anageriPerson inuarge
1711 -Carpenter, Scott 0 1 / a 0 / a 0 1 0 1 / '2 0 / a 0 1 a
5148 It) Date.
Title Date,
NU DeDartment of Envion'nental & Natural Resources
ew [E Transit ion a I
Dk,ision of Environmental I lealtl-
DateW/202012
Name of Eslabishment- 150Grilt
Permittee-Pall cia Royalll
Location Address 1Aq4HvYy150F
M a n ag e rP ers on in Charge. Pairirin Roynil
City: Terfdl 6tate I NO ip: 28682
_couny 'a
B I I I n g N am e, PaIricia Royall
Status Code, T
BillingAddress: 1894RWy150E
Establishment ID., 2,019011210
Cty: Terrill Stato: NC Zip: 28682
Map #: — — — — — — — — — — — — — — . parcel ID: — — — — — — — — — — — — -
Email Addrebb.
Lal - — — — — — — — — — — — — — — Lirig . . . . . . . . . . . . . .. . .
Phone: 02,8) Fax
Erieroency :'hone Number: ((U4) 3:Y9,�846
Permission is granted to operate 8 1 - Reslaurant
as defined in G,S, 110Au247(1) and 12OA-24G,
Peculation of Pond and Lodqinq Facilities. See permit requirements in Pules. This permit is not Iran sferaole and mar be revoked forfailure to
comply -vv th all rE q ui,e ments,
W o otemato r Cylote ma: F_]MuricipnlfCommumty oro n-0ito Systocapacty:
Mon
36 Category 0'
woter Supply: E1Muric1paYC)mnoumi -Site System
PushcirtNobil@ Food Unitope,afing in comuncion with
Restaurgnt or Comm ssay Name and ib—ii]mReT
('rndifinnajRemar1kA'
Ectaollshment assigned to: 1711-Carpentor, Scott
NEED TO FINISH WITH CHANGING OUT CEILING TILES IN KITCHEN (I TILE)
AND IN ROOM WITH WALK-IN[ COOLER ANr, MIDDLE PREP ROON1
SEATING SHALL NOT EXCEED 38 SEATS
[jAte chm ents
Transitional Permit Conditions
—his permit shall expire Qi 0711812012 end is n Qt renewable. A 11 in7 n- cQ mr lia n' ile m S listed herein a n 0 on alta c he J pages (it
a top L, a b P.) must se completed within 90 [El 00 days daws. This establishment mist close, if all noncompliant rems are not corrected loi thE
expiration da7ii�,
RoQcived By, �011.0/2012 a & Title Date-,
M an a ;lefpe rson in 0 riarge
azant;� P;�C 171 I -Carpenter, Scot OVW12012
Qiqned. R'#. Date:
Division of Envy fon m entail He@ Ith
Purpose: General Statute 130A 2/9(b',stats[;"No ectablohm5nt. shall commence or continue opemtion wthout a pefrnit ortiannuoml permitiomed by the Department.
Thep ffrnit or transizonal p emnit 4aall be i ssueil to the owner or operator of the establishment and shall noL be -mrifferable. Ifthe establishment is leased, the pernit or
transitonal pemut shall be ismedto the lessee and shall not be transferable.. Ifhe locaton ofan estathshment changes, a newlzimml shall be obtained for the
establishment. A permit shall be issue only vken Le establishmmt sati s fl es all a f -,he requirements c f the rules. The Commission shall adopt rul es est€bli shing the
requirements that must be met before a transitional -j ernit may b e issued, and the p en o 6 fbr whi ch a trans.ti onal p ernut may b e is suel. The D epartmeff, may al so impose
UndiLuns on Lhuissudnuu ufd paiiAl, UI LimilibalaulA 1JU1111A ftl duuuIddiii-xvvill. iulus ddipLud by Llir- Cummissiun. A ptliniL ui LrdnnlauiiaJ ptaujil, slj;=Ill bu ii-mir-diat.dy
rev okc d in accordanc e with G. S. 13 OA -2 3(d) for failure 3 f the establi Ehment to maintair. a minirrum grade of C. A permit or tarsiti cnal permit may otaerwi se to
so sp erded or revoked in acccrdar.ce with G. S. 13 OA- 2 3.. " Preparation Lo Dal environmental health specialists 3hall issue a permit every time a change in p eornit status is
indicated. Prepare an ori 3ia and one copy for. 1 . Oxi 0mal to be left with :he owner or operator. 2. Copy for tl-.e 1 a cal health d epartnamt. Disposition: F1 ease refer to
Records R ftent. on and Eli sp ositi on Schedule 8,8.5.. fbr -_ ounty/Di strict H m1th Departments whi:h i s pub.i shed by the North Ca: olira Dim si on o fArchives & Fi story.
A Iditionai forms may be ordered from: Diui si on of Environrmlal Health, 1632 Mail S ervi ce C enter, Raid gh, NC 2 7 6 9 9 -16 3 2, (C ouh er 5 2 - 0 1 - 0 Q
DENR 1341 (revlspd 02fO8)
E ry iron m enta I Health 8 e ry c e s Section ction (review M 8)