HomeMy WebLinkAboutBella Rose Restaurant Permit 011214 02 07 12.SC.pdfTime In 1 0 5 [N,3rt Time Out: 1 1 : 1 1 [EaM Total Time: 21 minutes [:]New [ETransitional
Elpm - -Elpm
B e I I a R o s e R e s t a u r a n t
Name of Establishment
6 6 1 0 N C H w y 1 6
Address:
C o n o v e r N C a 8 6 1 3
cfty: State: zip:
B e I I a R o s e R e s t a u r a In t L L C
Permitlee
M anager or Person in charge
[:J Mailing Address Same
B e I I a R o
s
e R e s t a u r a
n t L L C
M ailing Name
P 0 B o x 1
3
0 6
Mailing Address
C o n o v e r
N C a 8 6 1 3
City;
state: Zip:
( 8 28 a 5 6 - 1 1
4
21
( 8 a 8 9 8 0 2 5 8 4
Phone
Fax
Emergency Phone htUrr�ber
1 8 C atawba
Email Address:
F.-,jnty#
5-5 - Municipal/Community
4-4 - On -Site System IV
01 7 4
Water Supply
Wastewater System Risk Category
Territory # Capacity:
a 0 1 8 0 1 1 2
1
4 2 0 1 8 0 1 1 1 7
7 1 -Restaurant T
Facility ID F1 Existing Facility?
told Facility ID:
Operate a: Status Code
Attachments
Map # Parcel ID: #
0 .1 / 0 7 / a 0 1 .1
Lat. Long. Date:
Push Cart or MFU [:]Pushcart [:]M FU
PushcartlMobire Food Unit operating in conjunction with: Restaurant or Commissary 10:
0 JE 0
Transitional Permit Conditions: Permit Expires: 0 8 / 0 5 / 2 0 1 2 09days 18
Non -Compliant items clays
completed by:
ConditionsfRemarks
Operate 4-9 Tuesday -Saturday, 11-3 Lunch on Sunday
Cannot exceed maximum seating capacity of 74 due to septic system requirements
Letter will be sent on info for transitional - things to finish fixing
Establishment Assigned To
1711 -Carpenter, Scott I I/
signaturid': M anageriPerson in charge
1711 -Carpenter, Scott 0 a / 0 7 a 0 1 3 0 a / 0 7 / 2 0 1
EHG ID Date: Title Date:
P J
NU DeDartment of Envionnental & Natural Resources
ew [E Transit ion a I
Dk,ision of Environmental I lealtl
Gate 021M2012
Name ofEslabishment- Bella Rose Restaurant
P erm itte e, Bella Rose Restaurant LLC
Location Address 681OP4('H%vy16
ManagerPerson in Charge:
City: QjIlave'r 6tate I NC 1p: 28613,
couny 'a
Bi ling Name- Bella Rose Restaurant LLC
Status Code T
Billing Address: POBolt 1306
Establishment ID, 2019011214
cty: GOMM, Stag : NC Zilr): 28613,
Map -,f: - - - - - - - - - - - - - - - Z) a ro, 9 1 ID: - - - - - - - - - - - - -
Email Address.
Litt. - - - - - - - - - - - - - - Ljriy . . . . . . . . . . . . . . . . .
Phone: I828lZbb-1142 _Fax:
E ri e ro e ncy h o ne N um b 9 r: (828) 9M-2bB4
P e rm i ssJ o n i s g ra n to d to o p e ra to 8 1 - Restaurant
2) s d of i r) e d in G, S, 1 0 0 A- 2 4 7 ( I ) a n d 12 0 A- 24 G
Peculation of Pond and Lodqing Facilities. See permit requirements in Pules. This permit is not transferaole and mar be revoked for failure to
comply vv th all he q ui,e ments,
W a otemate r Cylote MO: F-IM uric ip n uO aro mu n ite M* 0 n-0 ito Oysto ro capacty . 74
Category 0'. F11
W
',Water Supply: IMM uricipaIM)mmunit On -Site System
PushcirtiNobil@ Food Unit ope,ating in conjuncion with
Restaurant or Comm ssay NMe anFib-ii]rl ReT
Crnditinn.qRernarIA,
Establishment assigned to: 1711-Carpenter, Scott
Operate 4-9'Tuesday - Salurday, 11 -3, Linn on Sunday
Cannotexceed maximunnseatin9capacity of 74 duetoseptic system requirements
Letter will be sent on into for transitional - things to finish fixing
Transitional Permit Conditions
-his permit sh a 11 expire of 0,8105P2012
a no li, a b P.) must o e c 3 m plete J within 90 / [El so days
expiration da7e.
Igimilil
on in charge
and is not renewable, All n o n- cQ mr lia n, Items liate d he rain a n 0 on alla c he d gages (it
days. This establishment mast close if all noncompliant Gems are not corrected loi the
HIM
n;;tp,: 02AM2012
sinned: RE#: 1711-Carpenter, Scott Date: 0207/2012
Division v ron m entl I Health
Purpose: General Statute 130A 2,'8( , stratr5c; "No ectablohmmt shall --offimence or connnue opemirion vathout a pffmit or tianoiuon-cl permit ocued by the Department..
The permit or transidonal permit 4aall be issued to the owner or operator of the establisl=nt and shall not be:ranfferable. If the establishment is lensed, the pertnrit or
transitonal pewit stiall be issued to the lessee and shall not be tnnsferable. If 'he locaton of an establishment changes, a newpermit shall be obtained for the
establishment. A pffmnit shall be issued only vken Lie establishmmt satisfies all of',he requirements cf the rules. The Corarnission shall adopt rules est,-:blishing the
requirements that must be met before a transitional -jernit may be issued, and the perio6 for which a trans.tional pamtrmy b e issuel. The Departmieff, may also impose
UndiLuns un Lhuissudnuu of d puml, ui Limilibalaunal pulujil, Jn dL;L;urL1a.Ii1_;r_Vvi [I. I ul US ddipLua by the CullulASSiUll. A IRMAL J1 11-d1Ml11J11dJ PU111111, shall 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 rninirrum grade of C. A permit or trar siti cnal permit may otaffwi se to
su sp erded or revoked in accordance with G. S. 13 OA- 2 3.. " Preparation Loyal environmental health specialists 3ha11 issue a permit every time a change in pewit status is
indicated. Prepare as ori 2�n and one copy for. 1 . Oxi Onal to be left vith :he owner or operator. 2. Copy for tl-.P- 1 o cal health d epartmmt. Disposition: F1 ease refer to
Records R etent. on and Eli sp ositi on Schedule &B .5.. for ounty/Di strict H n1th Departments which i s pub.i shed by the North Ca:olina Dim si on o fArchives & Fi story.
A Iditionai forms may be ord--red. from: Diui si on of Emrironrmial Health, 1632 Mail S ervi ce C enter, Ralei gh, NC 2 7 6 9 9 -16 3 2, (C ouA er 5 2 - 01 - 0 Q
D E V4 R 1.341 (rev Ise J 0 2fO8)
E ry iron m enta I Health 8 e ry c e s Section ction (review M 8)