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SUFFOLK COUNTY DEPARTMENT OF HEALTH SERVICES
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MD,W11,MBA,M$
W TO OPERATE A FOOD ESTABLISHMENT
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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
SUFFOLK COUNTY
DEPARTMENT Or HEALTH SERVICES 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 REQUIREMENTS OF THE
STATE SANITARY CODE ARE WAIVED PENDING CONTINUED SATISFACTORY COMPLIANCE
WITH THE PROVISIONS OF PART 5
I .D. t� 91238
t APPROVALS
ESTABLISHMENT NAME:
-4- SOUTHOLD HUNAW RES. CTR.
7-
ESTABLISHMENT ADDRESS: 750 PACI.FIC STDEET
1ATTITUCIt
OPERATOR'S NAME:
SCOTT A. RUSSELL, SUPERVISOR
ISSUE DATE: 12/04/15
EXPIRATION DATE:, 16
PERMIT ISSUING OFFICIAL
RESTRICTIODIS
------------
HECHWICAL DISHUASlER REGUIRED TOUN OF $OUT01LD
APPROVED FUR NOT KAD COLD DELIVERY E. NEVZLLE, TOW.', CLERK
po BOX 1279
SOUTHOLD
my 11971
IF NOT DELIVEREd II;llt�l"���E�tltlll„i�11111'I{Itlt''!,"tlltl_'ttltlllltl,' Haslet FIRST-CLASS MAIL
SUFFOLK COU " . CONTROL 12'/0712015` $00.982
360 YAPHANK AVENUE, STE. 2A
YAPHANK, NEW YORK 11980-9744 °'° �` ZIP 11788
011D12601731
FI ST LASS MAIL
� ® FOOD ESTABLISHMENT PERMIT ENCLOSED
STEVEN BELLONE JAMES L.TOMARREN •.
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SUFFOLK COUNTY EXECUTIVE O' MD,MPH,MBA,MSW
r • COb1MIS3IONER `
SUFFOLK COUNTY
DEPARTMENT OF HEALTH SERVICES
RECEIVED
DEC 1 6 2015
Southold Town Clerk
T'OVN OF SOUTHOLD
_
E. NEV a LLE TOW CLEIRK
PO BOX 1179
SOUTHOL® y
NY 11971 '