HomeMy WebLinkAboutBayou Billy Permit 730825 10 10 14.jh.pdfTime. In: 1
1
D ani Time Out: I E3 aM T.1.1 Time, f MillUte
ANew [:]Transitional
91,
PM El PM
B A Y 0
U
9
1
L
L Y
Aerie of Eslabllsh.nne ril
0 K T 0
B
E R
F
E
5 T
Address I
� 5 0
7
N
w
1 6 0 T H P L
Address 2'
H I G H
S P
R
I
N G S . . . . . . . . . . . .
F L 3 1 1 3
City.
Slate: ZIP:
B A Y 0
U
B
I
L
L Y
pernfle q,
M anager or Person, in charge
[E tv am rig Aodress sarne
6 A ly 0 u B I L L Y
M allIng Name
0 K 7 0 E E R F E 5 T
M atirrig Address 1
2 6 2 0 7 N w 1 6 0 T H P L
M ailing Ad lri3s 2
H I G H 5 P R I N G 5 F L 3 2 6 1 3
City: pp -Stale z —IF
Phone Fax Emergency Phone Number
1 8 Catawba
ErftallAddress, re—u-nTy—#
MUnii dpa VCornritui ii ty 3-3 - MunIcipal/Cram niunity NfA 01
Water SuvVy Waslewatier System RisK Category Ter0toryg capacity,
4*aEnterias�40,igascwy 7 3 - Temp iera ry I
— -- — ---------
Facility ID Old FaCMY 0: Operate a., STara Code
Map ie Parcel 10 #
LW)9v ar
[]Pusncarl [:]MFU
PusncartfMabile Food Unrl aperahng Iry corpjunct0ii wilhl-
[:][:] s
Transitional Permit Conditions:PermirExp&ev So days 1 o daysNon-ComoharltitfeMS Completed by'
Condit lonsiR a rna rKs
MIJNMMFri$ i�
Non-Cornpliant Remarks
0 vtA� the chfvu'x w i4d g-Mods,
Esfabfisnmeni' ssigned To-
1664-Huffinan, Jason
H Si n ie anageOlPerson in charge
1,654-Huffman, Jason 1 0 1 1 Ir 3 9 1 4 1 9 Jr 1 0 / D 0 1 4
EH8IGr Date, Title Dare.
im
M
M
RIC Department of Health and Human Services
Division of Public Health
Errvironmental Health Secibn
[#]Permit [:]Transitional Permit
Name ofEstabhshment. BAYOUBiLLY Permittee- BAYOU BILLY
Location Address, OKTOBERrEST 26207 NW 160TH PL
cly- HIGH SPRINGS State: FL , Zip. 32613 Manager/Person in Charge'.
BilingName- BAYOUBILLY 11 County- Catawba
BilfingAddressCKTOSERFEST26207NW10THPL
Cjy:: HIGH SPRINGS
State- FL zip 32613
Status. Gode�
Emaif Address: Establishment ID: 2016730825
— -------------------------
F a�x Map #� Parcel ID
---------- -------------
Emergency Phone NLImber Lit` -____._-- _ ------- Lonq ................
Perm,ion i%grant t pp rr t1 73 - Temporary Food Establishittent , 0 fined in Q_1 -24 7(1) and A-24,
as
Regulationof FDQd and LodRing Facdill e5, See permit requirtrnenJ5 in Rules. W5 permit is not transferable and may be revoked forfailure to
compty wilh all require ments-
Vda'stewater systems, [FulunicipapCommurray Dorl-silo sislem capacflyCategory W R1 El [E
Water Supply, N]v urticipm;communny E]On-Sile System Ifl M
Pa�j Unil operaVrig in, voklit', Reslaurantor Cyrrimissary Name an - 5—o—urn—t—er — — — — — — — — — — —
Candiflons)'Remarks:
Estaollshment assigned to: 1654-Huffman, Jason
OPERATE 1010 14-101214
E]Attacnments
TrIMS11110nal Ponnit CoMdfltloloS
This perrnn shall expire on and is not w0watite, A," hS444 bervqn, and on attached pages t"If,
applicable) must ise, completed witNn D go / E] 180 days dalfl,, Thus estabhshm4nt Murd C100 it all IIeMS atenA CorreCt4d, dy the
expiralion date,
Received By: TWe, Date: 10,110,2014
ki an ager Person in criarge
signed DyR6,Helq; 1654 -Huffman, Jason [)are-, 1411112014
is n r U i a n St
Rk, V"Al VuAr,
01
I " on shall r -ontinue operation irdthow, a perntrit or transitional periarit is-_qre�d by the Departrinent-
A A
pulpose� clewral Statute 1 1=1 sz. I h1nie commence at c
The petmrt of tratrational It shall be issued tthe mrner or operator of the, establish rwntarnd shall not be transfenHale. If theesmbdishment is leased, the petran or
tram si iional lomnit shall ire, izued to the to -we and shall net be transferabl.c. If die location of an establishmnit cl=gn, a newperrnit slitall Ice obtaimed for the,
estabfishment, A pennit shall be issued anlywhen the establiament.satisfies ali of the requarmients of the niles - the Commission shall adcrirtrules establishing the
feqWfematits thatmust be met before a trlussifional pertrit may be, rrisut,4. and thepetiod ;fat mlaidi a tninsitional ptirtyrt may tee issuz,& The Dcisafnnent =yalw inpose
cand dons on the kqlance of a pernit or tsars g tin pemit in acLonhnce mith rules adeptedby the Contrin ssion- A pernit or trareitiona1punmil stall be iniarittliately
rear uktdin accordancevOth G-S, 130A-23(d) for Wure of the eMblqhtnent to mairittirm a anto I muen grade of C, A pemzT or transitional permit nuv orhent! se be
suspendedorlevoked in accordartceMyth G. S, 13 DA-23.- ' Preparation: Local mll�wttrnrntal heorlth-spectalp As shall issur aperrrdrrven,� time a chamge in permit.eta tusis
indicated. Prepire anon Sinal and one copy for, I - oligsnA to be left rat tit the av%mer ar operator- I Copy for the, local health delileast-INspostrorr Please reff"r to
RecoidsRetetrution and Dr slims Sdtedtae S3.6, for CounmVisttict Health Depam, entsofich ispub lished by the'Xofth Carole na IAisioll,OfAfxlirves History.
Additional )oohs mav bt grideted from- Enwortmental Heallb 9ffcdviy, 1632 Max[ Senice Center, RaleighLe NC 2760 -16.32, (Courier 52-01 -00)
EH& 1341 (revised DTF121
Environmental Health Sechon
Comment Addendulm - Attachment
Establishment Name- BAYOU BILLY
Establishment 1[)- 2018730825
IDate. 1,01012014
NUMEM
CRY: HIGH SPRINGS State: FL
C,oUnty: Catawba Zip, 2613
Wastewater System: e Munbipalhaammuni,ty 0 On -site System
Water Supply: 8 municiparcommunity 0 on -dike syltem
Permittee: BAYOU BILLY
a&=
ConditionslRernaMs (continued):
Non-C orn pliant It e rn s: