Laserfiche WebLink
<br /> <br />1m ~Ice machine installed in protected area and properly <br />drained <br />IE ~ Displayed food protected <br />D N~RUnning water dipper well for bulk ice cream service <br />D Equipment to maintain proper food temperatures <br />~ Refrigeration _Hot/holding units <br />III S; Laundry facilities properly located <br />IIi] ~ Designated areals) ,for employees' personal articles <br />II] ~Designated storage area for maintenance and cleaning <br />equipment <br /> <br /> <br />Mop wash facility with hotp.qd cold running wa <br /> <br />to sanitary sewer locatioA::> <br /> <br />IE] ~Faucets with hose fitting and hose bibs to have back flow <br />protection device <br /> <br />1m '~BacksiPhOnage/backflow protection if no air gap/break <br /> <br />1m ~ Refrigeration waste piping shall discharge indirectly into <br />floor drain or other approved receptor <br /> <br />C" Adequate number of public restrooms provided <br /> <br />5- Hot/cold water to all lavatories utilized by employees <br /> <br />5-Doors to be self-closing <br /> <br />~ Restrooms accessible by customers without going through <br />food preparation, food storage, or ware washing areas <br /> <br />IIil Comments: <br /> <br />I <br />",,1m <br />III <br />IE <br />IE <br /> <br /> <br />II] <br /> <br />~ Waste container, grease receptacle, co\"p~c~ on non'ab- <br />sorbent surfaces.DlA )'V\4/S i:'tY' <br /> <br />_Compactor area drained to'sanilary sewer <br /> <br />IE <br />D <br /> <br />Comments: <br /> <br /> <br />Light fixtures required to be shielded, coated, or covered where food is <br />stored, prepared, displayed, or where food is open or exposed. <br /> <br />DBPR Form HR 5021-011 (Formerly BPR 21.011) <br /> <br /> <br />B <br />m <br /> <br />o On-site Well, c;J Other <br /> <br />Supplier Name: <br />Written approval for use issued by: <br /> <br /> <br />B <br /> <br />D <br />OJ <br /> <br />B <br /> <br />Public well permit number: <br /> <br />o Package Plant 0 Septic Tank System <br /> <br />Written approval for use issued by: <br /> <br />System name: <br /> <br />Septic Tank System permit number: <br />Tank size: gallons Drainfield: <br />Grease Trap:] ~O gallons Location: <br /> <br />square feet <br /> <br /> <br />1m Seating capacity as indicated by plan: \ 0 fY'\D')( <br />D 0 Plans approved as is date: / / <br />~ans approved with noted provisos date: .li1d.1/ 0() <br />o Plans denied date:_/_/_ <br />Resubmit corrected plans as indicated <br /> <br /> <br />Provisos/comments: <br /> <br />Applicant name: <br />Please print <br />Applicant signature: <br /> <br />date: ---.!---.!_ <br /> <br />Renumbered 1999 May 25 <br />