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Home My WebLink AboutApplication 454 Ellington Road Town of South Windsor — Health Department c 1540 Sullivan Ave., South Windsor, CT 06074— Mailing Address 1530 Sullivan Avenue, South Windsor, CT 06074—Office Address Phone Number: (860) 337-6173 Fax: (860) 644-1930 SOR•Cl� Restaurant Establishment Information New Permit❑ Permit Renewal ***(Please Print Clearly)*** Name of Establishment: Manager's Name: • �t Unc C q� Street Address: y'-{ '2-`1 tc\ kvn ' (ZI 1 City, State, Zip Code: Phone#: 6(.0��J Cell Phone#: Fax#: ,U C_A?� E-Mail Address: ,3 ,^cA Seating Capacity: Please submit latest copy of the Qualified Food Operator/ServSafe certificates to there office. Qualified Food Operator: YES�d NO ❑ (Required for Certificate#: Class 3&4) I U 3 G Name: ' ND -e Date: Testing Organization: (ZQS� �,r �, �, Phone#: E-Mail Address: XOn�� R�P� 0pnAlternate Phone#: Designated Alternate 1: Designated Alternate2 Restaurant Owner Contact Information Owner's Name: Street Address: O`3 \AA �—KW_ City, State, Zip Code: C�r aOC)CIA� Phone#: (� �`�!, >q a Fax #: E-Mail Address: n Gj C Cell Phone#: Renovations Were there any renovations made last year? YES❑ NO '4 Will there be any renovations? YES❑ NO�] If Yes, please list all renovations RECEIVED that were done/to be done: NOV 12017 SOUTH WINDSOR HEALTH DEPT. Mailing Address to send Food License Renewal Permit to: Name of Restaurant/Company: Attention: Address: L\ �(A City, State, Zip Code: C7K_ `{ Phone#: g ld OAS 112 Restaurant Menu/List of All Items Served/Sold Latest Menu Attached? YES NO ❑ NOTE"(ML]st 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 I( 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. i Applicant Name (Print): Applicant Signature: Date: 1 \� Office Use Only Inspector Name (Print): Inspector Signature: r� Date: vol,� , �1►�-I I�1 Food Class: 1 ❑ 2 ❑ 3 4 ❑ Expiration Date: Date Received: Date Approved: t L, ILI W 'Q c,;I -r-W�� 1 S 3 3 ServSafe National Re.StnUlant Assocntioi ServSafe CERTIFICATION ROXANNE CRAY For successfully completing the standards set Forth for the ServSafe®Food Protection Manager Certification Examination, which is accredited by the American National Standards Institute IAN504CZonferenoe For Food Protection(CFP). 10961203 10378 CERTIFICATE NUMBER EXAM FORM NUMBER 04iAVP 14 04/29/2019 DATE OF EA'A- MINATION DATE OF EXPIRATION Local laws apply.C with ymn local regAaiory obency for recertification requirements. - z ICA She 1 mlauranl A1WKiattan 5o111io�i p #0655 l] 0 �,aocadusca wigs Marien,e 1�o t R�--i2 a.r.�sa:l �. =15 Nofvsd wsL tii�as!p1#w we►odwwks of the NRAEF. Codact us with questions d 175 W Jadoon BW.Ste 1500,Chicago,L.60604 or S—Sofe0wjo-om.or% i 1 BUR' S- SMOKE.HOUSE. - - -_ - (860) 7 S-8771 / WWW.BEARSBBQ.COM = Smoked Wings* m BBQ Bacon Ranch g Romaine lettuce,cucumber,tomato red onion,cheese,and bacon. Dry rubbed and smoked. S10 no meat/S12 pulled pork,pulled chicken,brisket,chopped,turkey, S7 half dozen/S12 dozen kielbasa,TX sausage/S13 burnt ends MOINK Balls • Bacon wrapped meatballs. S7 half dozen/$12 dozen CHOOSE YOUR STYLE & MEAT: S Pulled Pork, Pulled Chicken Served on a potato roll. BEAR sized is double meat. Brisket, Chopped, Turkey, Kielbasa, TX Sausage Top any sandwich with slaw S0.50. S1 2 / Burnt Ends S13 Pulled Pork Mac Attack Pulled Chicken Mac and cheese topped with meat. Brisket BBO Bowl Chopped (pork & brisket) Combread topped with bbq beans and meat. Turkey Breast BEAR Attack Kielbasa Combread topped with mac and cheese and meat. Texas Sausage - Jalopeno and Cheddar Super Spud S9 regular / S 13 BEAR sized Baked potato topped with mac and cheese and meat,then loaded with sour cream,bacon,red onion and shredded cheese. Burnt Ends Paw Paw's Poutine S 1 1 regular Hand cut fries topped with meat and cheese sauce. Cn f(144.A TQU7LL�! Df�cLt• Choice of dressing:Balsamic, Ranch, Blue Cheese, Honey Mustard, or Light Italian. Extra dressing S0.50. Feeds 4-5 people m Garden Salad Includes Full Rack of Baby Back Ribs Romaine lettuce,cucumber,tomato and red onion. and your choice of: S6 no meat/Sl 1 pulled pork,pulled chicken, brisket,chopped,turkey, 1ound of an meat kielbasa,TX sausage/$12 bumf ends p y 3 pints of any side m Sweet Mama Bear (may substitute 3pcs of combread for any pint) Romaine lettuce,cucumber,tomato red onion,cheese, candied walnuts and dried cranberries. S50 / S53 Burnt Ends S10 no meat/S12 pulled pork,pulled chicken, brisket,chopped,turkey, kielbasa,TX sausage/S13 burnt ends Consumer Advisory:Consumption of raw or undercooked meat,poultry,eggs,or seafood may increase the risk of illness. 'Please note Bears Smokehouse uses peanut oil in our fryers. Prices Subject to Change without Notice b1, 4Z" sue, Served with choice of any two single serving sides. Smoked BBQ Beans Pulled Pork S14 Mac and Cheese Pulled Chicken $14 Mashed Sweet Potato* Brisket $14 Baked Potato* Chopped (pork & brisket) 514 Collard Greens (made with turkey)* Turkey Breast $14 Coleslaw* Kielbasa $14 Broccoli Salad* Texas Sausage Qalapeno cheddar) S14 Apple Crisp Burnt Ends $15 Salad* *Gluten Free S3 single / S6 pint / S12 quart Served with choice of any two single serving sides Handcut French Fries* 2 Meat S16 S3 3 Meat S 19 Cornbread Meat choices include: S 1.50 Pulled Pork Mza& h NW Pound Pulled Chicken Brisket Pulled Pork $15 Chopped (pork & brisket) Pulled Chicken $15 Kielbasa Chopped - pork & brisket $18 Turkey Breast Turkey Breast S18 Texas Sausage (alapeno cheddar)(4) wings Kielbasa $18 (4) moink balls Texas Sausage - Jalapeno and Cheddar S 18 Burnt ends (limit one) Brisket $19 1/4 rack of ribs (limit one) Burnt Ends S20 Baby Back Ribs Dry rubbed and glazed. Peach Cobbler $3.50 1/2 rack with 2 sides S 18 Bourbon Pecan Pie $3.50 Full rack with 2 sides S24 Contains alcohol. Full rack no sides S21 Apple Crisp $3 May contain nuts. Beef Ribs (weekends only) Dry rubbed and glazed. DliltkJ, Served with 2 sides S25 Bottled Water S3 No sides S20/lb Hosmer Mountain Soda $3 All Sauces and Rubs are Gluten Free. Sauces may be served on top or on the side. Four varieties of sauce: Kansas City Sweet, Texas Pepper (spicy), Hot Sriracha, Grizzly Ghost Pepper (hottest).