HomeMy WebLinkAbout946 Sullivan Avenue (11) Restaurant Menu/List of All Items Served/Sold
Latest Menu Attached? YES 2"NO ❑ NOT'E*(Must have latest copy on file)
Please list all menu items in as much detail as possible or a copy of a menu attached is applicable.
Additional Information
Please check one only:
State Licenses: [Bakery ❑ Liquor Permit ❑ None
Water Supply: /Public _Private Well
Wastewater Disposal: ✓ Public —On-Site Other(please use space below to explain)
Agreement and Signature
By submitting this application,I affirm that the facts set forth in it are true and complete. I understand that any false
statements or other misrepresentations made on this application may result in immediate shutdown or revocation of my Food
Service License for the Town of South Windsor.
Applicant Name (Print): -
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Applicant Signature: Date: _ , .7
Office Use Only
Inspector Name (Print):
Inspector Signature: Date:
Food Class: 1 ❑ 2 ❑ 3❑ 4 ❑ Expiration Date:
Date Received: I Date Approved: