HomeMy WebLinkAboutB & B Concessions 730764 08 27 14.pl.pdf111119MM
Address 2:
N E W T 0 N N C D 8 6 5 8
City: State: ZIP;
B A N D B C 0 N C E S S 1 0 N S
Permittee
M anager or Person in charge
E] Mailing Address Same
B A N D B C 0 N C E 5 S 1 0 N 5
M ailing Name
1 8 0 0 A B B 0 T T S G L E N C T
Mailing Address 1
Mailing Address 2
A C W 0 R T H G A 3 0 1 0 1
City: State: ZIP"�
Phone Fax Emergency Phone Number
1 8 C atawba
Email Address: Co5nty #
5-5 - Municipat/Community 3-3 - Muni cipal/Community NiA 01
Water Supply Wastewater System Risk Category Territory # Capacity:
0 7 6 4 44V Enter last 4 dglts only 73 - Temporary Food I
Facility tD 0 W Facility ID: Operate a: Status Code
M a p # ParcelAD #
0 8 7 0 1 4
Lat Long, Date:
Push Cart or MFU [:]Pushcart E]MFU
PushcartlMobile Food Unit operating in conjunction with Restaurant or CommissaryID.,
�90 days E]180 days
Transitional Permit Conditions: Pentrit Expires: Non Compliant items completed by:
Canditio n sIR em arks
cmal'"*rs
'9 am a wo
4000
Non -Compliant Remarks Ghck the checkbox to add ftoncompliant rema*s
Establishment Assigned To�
2031 -Levin, Paige
EHS(Sigattire
:
2031 -Levin, Paige 0 8 7 / a 0 1 4
EHSIDDate: ""I"I"I" . . .... . ...... . . . . . . . . ....... .
TRIe
M anager/Person in charge
0 8 / .2 7 0 1 4
Daze:
N G DepartMent ot HQ,a1h and H urnan Services [j] P—]Trerm it F ansitional Permit
D rtis,ian of Public: health
ealth
Environmontal Fic-alth Suction Date: 0812T2,014
Name cifEstab�ishnrlent'. BAND 8 CONCESSIONS Permittee-B AND B CONCESSION'S
azmzffr� 11010201���
Cty:: NEWTON
Biling Name BAND 6 CONCESSIONS County Catawba
BifingAdd ress28GUABBOTTS GLEN CT
cly: ACWORTH State:GA Zip: 30101 Status Code. I
E m a 0 Add ris ss: Establishment Q 2018730764
---------------------------
Phone: F ax: map #" --------------- Parcel It)--------- ----
t r n Phone Number Lat ................ . LonT ................
Permission: is granted to operate a 73 - Temporary Food Establishment asdefined in:G.S. 13,OA-247(1)and 13OA-248,
R,egulation of Food and Lodging Fact4tres. See permit requirements in Rules, Mis permit is not transfewle and m,,ay be reioxea fortadure to
compty wthall requi7ements.
Wastewater Systerns; R]m uricouc)mmunity [:]On -site System Capacly:
categarf 4: 91 E ff]
hater Supply: [Emuricipallcmrrwnjty Don -Site System El 21
Pushc3rtiNobile Food Unitope'ating in conjun0on with Restaurant orcommssa'y Name an -07i6'riiiTJ -- - - - - - - - - -
CcndjtionVRernarks:
F-stablishrrent assigned to: 2031-Le'vin, Paige,
I AttaChments
Tran%itional Perm it Conditions
-hi$ Vermit shall exDjre Qi and isnot renewable. All nzri-comrlian, items listed herein and on anaChed sagas (if
211akable) must as c;DrnDlete J within 90 / [:]180 dams days. This astablishment mist close, if all noncomialiant i*ems ors not corrected lov the
expiration dwe,
RoreNed Ry Tit pr
M BriageriPerson in Charge
I
n,t,- =27t2014
Signed BY: v4—Z'4- All I- Z RE,HS#: 2031-Lervin, Paige Date: 0812712014
vision if P(vblic Health
Purse: Glenlerzl statute I- 24,8(b+, rtats "No ectablirlimscat shall -_ommetice ar continueoperation Nrathout a pmnit or trmoitionl pmmmit ism3ed by lire Depattnwnt-
lit permit or transitional peenit shall be, i sued to the 4ymaer or ator of the e abtti &1mrnt acid shall not be transfarablet- If the establi shnent i s lea sed, the perrat or
tranat onal ptim t shall be i saued to the lessee and shall not be transkrable.. If tie lo catian of an it stabli Flment rhariges, a utNN, M. mi r shall be obtained for the
establishmmt- A perrait 31rall be, issued only NNiien the establislim,-,,rit satisfies all of the, ir:qoiiements cf the aides - 'Me, Comrnission shall adopt nates establi &bing the,
requirements that must be, met before a transitional pemt may be, issued, and the period for %ludi a tirans.rional ptimutniay be ismed. `Ile Dtparhment may also impose
Lc,ndituns uri the ismarice, uf a pnTnit of nannaundl purrilft ni AcLulddnim %Nifl- rules adoptod by the Canirnis-duri- A peat Lyi transauunal pninft aliall Lm irmiudiaLdy
i-e,,�rokedinaccordance ,;xithG-S- BOA-23(rij for failure of the establish rnerittornaintair amtrurrutirtgrate of C_ A pen'rut Cg trar.stticnal pennitmav, ot�erlNise le,
sal sperdedorre%,,oke-dits ,a.ccc,rdarce,with G-S- BOA-2-332 Prepwation: Loml mNironrncntal healfli serialists shall issue pertnit eNery time a change, in it status is
indicated. Prepare an original and oche copy for: 1.firs gru2l to be left oath the vvvner or operator. 2. Copy for the local heaIttidepuan-int- Dlspamtion: Flea w refer to
Records Retentim and Disposition Sdedule 8 B.6., for Countyy,Eii strict Health Dep. rftrmts, iN,,hi:h is pub' i shed by the North Cxolina aa si on ofArzhwes & hi orb,:
Additionalfonnsmay be ordered from: Ens irownental Healln. Sezznor., MD2)fail
EHS 1341 (rovisoO OT021
Ervironmenta] Health Section
Comment Addendum - Attachment
Pstahb- irrert ANn A CONCF-,SSIONS -
Locabonaddress: HICKORY AMERICAN LEGION FA�R
NEMON
aou nty:
M�
Wastewater System: (j) muntipavc-r-unity C) On-Sitp System
Water Supply: 0 Muni-cipavcOMMUnit/ C, on -Siva -system
Permiltec BAND B CONCESSIONS
9XIM
Con dlflonsiRemarKs icontlnu@0):
tqon-'.orr,P1iait1tems;
Date: 08/2V2014
Status Gode: I
C atego ry 4: 0