HomeMy WebLinkAboutBack Yard Burgers Permit 011219 03 22 12pm.pdfTimeln: 1 m E913M Time Out. 1 1 ' 4 5 Mam Total Time: 53minutes,
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B A C K Y A R D B U R G E R
Name of Establishment.
a 3 9 1 N CENTER 5 T
Address;
H I C K 0 R Y N C a 8 6 0 1
CIY: State: ZlP:
B Y B G R 0 U P 0 F H I C K 0 R Y L L C
Permitlee
M I C H E L L E Q U E E N
M anager or Person in charge
[] lowling Address Marne
B A C K Y A R D B U R G E R
M ailing Name
1 0 ;2, 0 E A 5
T
C H U R C
H S T
M ailing Ayidress
C H E R R Y V I
L
L E
N C 8 0 a
City:
�I_ate Z_�P,
Ph one,
Fax
ennorgeny Phone Number
KKELLEYMJS@GM,At'L.COM
0 1 8 Catawba
E rn a il address:
Fo - A I _Y*
5-5 - MunicipaMorrimunity
3-3 - MunicipattCommunity
11 01
9 a
Water supply
Wastewater Systern
Risk Category Territory
E_a_oacltv
1 8 0 1 1 a
1
1 8 0
1 0 7 8 1 1 -Restaurant
T
Facility ID [] Exming, Faclity?
Old Facility ID:
operate a,
Status Code
[]Attachnrlents
W-ap _9
'Fa r —ce I t D
0 3 a 0 1
Lai..
Lon g,
Date;:
eMjb_P_kq_0LM E]Pushcarl
[:]MFU
PushtrarnrMobfle Food Unit operating, in conjunrlion wlth: Restaurant or Commissary I.
goR]
Transitional Permit Conditions: Permit Expires: 0 9 / 1 8 0, 1 .7 , [] days 180days
1,111 ornplia nt iteMS torripleted by:
GendilionslRemarks
Repair all baseboards) floor tiles. Regrout areas where, needed.
Replace paper towel holder at back handsink.
Repair area around back handsink, and regrout around it,
Paint or otherwise repair walls in back room by canwash.
Need to replace any ceiling tiles that are missing or are not washable.
Replace missing light oovers.
0 EHS Signature,
203 1 -Medfin, Paige 0 3 1 ;2 0 1 2
EHSID Crater
Estab4shrmenl assigned To:
2031-Merflin,Paige
MairrageriPerson in charge
0 3 / a, a 0 1 ;2
Title Dalle:
NC Department of Environmental & Natural Resources [:]New [ETransitiono
Dicrtsion of Environmental Health
Date. 0312212012
Perm eoll'Estabfishmen BACKYARDBUIRGER Permittee M, GROUP OF HICKORY LLC
Location Address: 2391 N CENTER ST ManagerPerson in Charge: MICHELLE QUEEN
City: HICKORY
State._N_C Zip- 28601 County-2-111
BfingName- BACICY ARDBURGER Status Code T
BillingAddress, 1020 EAST CHURCH ST Estabbshment ID: 2018011219
----------------------------
It '
CHERRYVILLE 'tat "NE Zip, 28021 Map * Parcel ID�
--------------- --------------
ErriaiiAddress- KKELLEYMJS@cDGMAIL, C0M Lat ------ L ---------- . Lonq�___ .............
Phone(828025-4948 Fax - (704) 445-1456 Emergency Phone Number: (828)781-1569
Permission is granted to operate a I - Restaurant as defined in ('c,S, 130A-247(1) and 130A-2480
Regulation of Food and Lodging Facilities. See permit requirements in Rules This permit is not transferable and maybe revoked for failure to
ccimply,kth W1 requirements.
waste wabir Systems: *MunicipauCommundy on-sile System capacgly: 92 calegorf IE
Water Sunni, M unicipaUCommunity On -Site System
H M M
PushcartlM o bile Food Unit operating in conlunmon wfth�
Restaurant or Commissary Name an 16-11Zrri67
Condilron$IR ornarkS.
Esla blmhme nl assigned to; 2031-Medlin,Paige
Rapall' all baseboards) floor files. Re rout areas where needed,
Replace pipertowell holder at back hart sink.
Repair area around back hand ink, and regrolut arorprid A,
Paint or olberMse repair walis in back room by caawash,
Need to replacre any oeding tiles that are missing or are trot washable.
Replace missing light covers,
[]Attechments
Transition at Permit C oInd itions
This prianit shall expire on 09I91d12012 and is not renew@bW. All non-comphanil items listed herein and on ailached pages of
applica bW) must be comiaeted within 090 / Efll GO days darts, This establishment must close if allnoncompliant items are not corrected by the
expiration dale
Received By: Title: Date: OW2i2012
ManageflPerson in Charge,
1'\
Shined, j'0,0,4. 0, A� 11 Llt'_� RS*: 2031-Medlin,Paige Date: MV2012
DRmsion of Environmental Health
ptupose: Gerlexal Statute 130A.248(b) states "No elablishirtrots loill commence, or confinde operation w1hout a permit art sittarlal pn=tissued bytheD"rtmerd,
The pena-iii, ortransifional penni,tdials be issued to the owmeroroperalorof the esdatilrst rflt icl shall not be transferable Ifth.cestabliiihmsit is leased, the penrit or
trawouarral pennit shallbe issued to the lessecaiad gall not be truisferable. If the location of an caablisfiriaml, changes, a newpe=1 diall be obtained for the
eelabhshment. A perucit shall be issiard only Aien, the establishment satisfies all ofthe rerpArernants ofthe riles , The Corrunission4all adoptruces ectablislirpthe
reciraremads that must bemet before atransitional perrral may be issued, and the penod for Mucha limsit onal pet rrot, rmy be issued. The Departrnentrrayalw impose
revoked in accordance vnth G, S. l 30A-23(d) for failure of the establishrrient to maintain a rnininnurn grade of C. A pewt or transitiorial pernt t rmy othavvise be
suspffided ar revoked in acmrdanrewith G13 DA-23--' PreparationLocal enrinonmentall health spedalists shall issue, a pern.'rit every, times changein pennit stable is
indicated, prepare an original and one copy for 1, Original to be left ysith the owter or otimtor, 2. Copy for the local health department, Dispositiot: Flease refer to
Records Retentim and Disposition Sloe &B 6,, for C ountyiDistnict Health, Departments which is published bythe Mortb Carolina Division ofAricturres & History.
Additional frim, s rmy be ordered from, Division ofEnvirclizwrilial Health, 1632 Mail Service Center, Raleigh, NC 27 699-163 2, (Courier 52-01 -00)
DENR 1 d41 (revised 021QB4
Environmental HeaMh Services Section (review V08)