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Home My WebLink About2009 SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES ' PERMiT ~,~° TO OPERATE A FOOD ESTABLISHMENT THIS PERMIT WILL EXPIRE UPON THE DATE SPECIFIED OR UPON A CHANGE OF THE OPERATOR. THiS PERMIT IS NOT TRANSFERABLE AND IS GRANTED SUBJECT TO COMPLIANCE WITH THE PROViSiONS OF ARTICLE 13 OF THE SUFFOLK COUNTY SANITARY CODE AND ALL APPLICASLE STATE, LOCAL AND MUNICIPAL LAWS, ORDINANCES, CODES, RULES AND REGULATIONS. iF THE FACILITY IS SERVED BY AN ON-SITE WELL THE DISINFECTION REQUIR~IENTS OF THE STATE SANITARY CODE ARE WAIVED PENDING CONTINUED SATISFACTORY COMPLIANCE WITH THE PROVISIONS OF PART 5. ESTABLISHMENT NAME: ESTABLISHMENT ADDRESS: SOUTHOLD HUHAN RES. 750 PACIFIC STREET NATTITUCK OPERATOR'S NAME: ISSUE DATE: EXPIRATION DATE: SCOTT A. RUSSELL, I2/10/08 I2/31/O9 RESTRICTIONS HECt~NICAL DISHWASHER REQUIRED APPROVED FOR HOT AND COLD DELIVERY CTR. SUPERVISOR I.D. · 91238 APPROVALS PERMIT ISSUING OFFICIAL TO~N OF SOUTHOLD E. NEVILLE, TOUN CLERK PO BOX 1179 $OUTHOLD NY i197! IF NOT DELIVERED AFTER 5 DAYS RETURN TO: SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES, FOOD CONTROL 360 YAPHANK AVENUE, STE. 2A YAPHANK, NEW YORK 11980-9744 S7 bVE ·EVt HUblAYUN J CHAUDHRY D O M S SUFFOLK COUNTY EXECUTIVE COMMiSS;ONER SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOOD ESTABLISHMENT PERMIT FIRST CLASS MAIL ENCLOSED TOWN OF SOUTHOLD E. NEVILLE, TOWN CLERK PO BOM ~79 SOUTHOLD NY 11971 SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT ....... ~".~ ....... . ................. TO OPERATE A FOOD ESTABLISHMENT THIS PERMIT WILL EXPIRE UPON THE DATE SPECIFIED OR UPON A CHANGE OF THE OPERATOR. THIS PERMIT IS NOT TRANSFERABLE AND IS GRANTED SUBJECT TO COMPLIANCE WITH THE PROVISIONS OF ARTICLE 13 OF THE SUFFOLK COUNTY SANITARY CODE AND ALL APPLICABLE STATE, LOCAL AND MUN~CIPAL LAWS, ORDINANCES, CODES, RULES AND REGULATIONS IF THE FACILITY IS SERVED BY AN ON-SITE WELL THE DISINFECTION F~EQUIREMENTS OF THE STATE SANITARY CODE ARE WAIVED PENDING CONTINUED SATISFACTORY COMPLIANCE WiTH THE PROVISIONS OF PART 5. ESTABLISHMENT NAME: ESTABLISHMENT ADDRESS: $OUTltOLD HUMAN RES, 750 PACIFIC STREET MATTITUCK CTR. 91238 ~PROVALS OPERATOR'S NAME: ISSUE DATE: EXPIRATIO~I DATE: SCOTT A. t2/10/08 12/31/09 RUSSELL, SUPERVISOR PERMIT ISSUING OFFICIAL TOgN OF $OUTHOLD E, NEVILLE, TO~N CLERK PO BOX 1179 $OUTHOLD NY 11971 IF NOT DELIVERED AFTER 5 DAYS RETURN TO: SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES, FOOD CONTROL 360 YAPHANK AVENUE, STE. 2A YAPHANK, NEW YORK 11980-9744 FIRST CLASS MAIL SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOOD ESTABLISHMENT PERMIT ENCLOSED RECEIVED Town TOWN OF SOUTHOLD E. NEVILLE, TOWN CLERK PO BOX 1179 SOUTHOLD NY il9?l FOOD CONTROL, SUITE 2A 360 YAPHANK AVENUE YA~HANK. NY 11980 ]'own of Southold Elizabeth A. Neville Southold Town Clerk Southold, NY 11971 "X" IF CHANGE OF ADDRESS ADDRESS CHANGE REQUESTED SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOOD CONTROL, SUITE 2A 360 YAPHANK AVENUE YAPHANK NY 11980-9645 SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES PERMIT .................... TO OPERATE A FOOD ESTABLISHMENT THIS PERMIT WILL EXPIRE UPON THE DATE SPECIFIED OR UPON A CHANGE OF THE OPERATOR. THIS PERMIT IS NOT TRANSFERABLE AND IS GRANTED SUBJECT TO COMPLIANCE WITH THE PROVISIONS OF ARTICLE 13 OF THE SUFFOLK COUNTY SANITARY CODE AND ALL APPLICABLE STATE, LOCAL AND MUNICIPAL LAWS, ORDINANCES, CODES, RULES AND REGULATIONS IF THE FACILITY IS SERVED BY AN ON-SITE WELL THE DISINFECTION REQUrREMENTS OF THE STATE SANITARY CODE ARE WAIVED PENDING CONTINUED SATISFACTORY COMPLIANCE WITH THE PROVISIONS OF PART 5. ESTABLISHMENT NAME: ESTABLISHMENT ADDRESS: OPERATOR'S NAME: ISSUE DATE: EXPIRATION DATE: SOUTHOLD HUt~AN RES. 750 PACIFIC STREET NATT I TUCK SCOTT A. RUSSELL, 12/10/08 ]2/31/09 RESTRICTIONS MECHANICAL DISHUASHER REQUIRED HOT DELIVERY ONLY CTR. SUPERVISOR I.D. ~ 91238 APPROVALS PERMIT ISSUING OFFICIAL TOi~l OF SOUTHOLD E, NEVILLE. TOUN CLERK PO BOX 1179 SOUTHOLD NY 11971 To~n of Sm~lhold TO USE ENVELOPE FOLD AND TEAR OFF BACK FLAP ONLY AT PERFORATION. 2. INSERT REMITFANCE STUB WITH PAYMENT. 3. MOISTEN SACK OF THIS FLAp AND FOLD OVER. PO Box 1179 Southold. NY 11971 "X"IF CHANGE OFADDRESS ADDRESS CHANGE REQUESTED PLACE STAMP HERE The Post Office will not deliver mail without Postage ~SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES FOOD CONTROL, SUITE 2A