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Home My WebLink About2017-11-30 - 1750 Ellington Road - Food Permit Renewal Application Town of South Windsor- Health Department r 1540 Sullivan Ave., South Windsor, CT 06074—Mailing Address 1530 Sullivan Avenue, South Windsor, CT 06074—Office Address s Phone Number: (860) 337-6173 Fax: (860) 644-1930 SOR•0 P5. Restaurant Establishment Information New Permit❑ Permit Renewal MP r*f***(Pleasee Print �Clleaarrly)**�* Name of Establishment: ��+��,/ LU/ Manager's Name: 13 Street Address: City, State, Zip Code: 7 y Phone#: !{�� 99 Cell Phone#: 4;!.ed690- 99R, Fax#: E-Mail Address: �?�oG7'p �/Ec�ktr! Seating Capacity: Please submit latest copy of the Qualified Food'0%Vt1or1ServSafe certificates to the office. Qualified Food Operator: YES® NO ❑ (Required for Certificate#: class 3&4) Name: �� R�j?e Date: Aza Testing Organization: �{AVAr' Phone#: 0-{f 3�•` `'`; E-Mail Address: JWvM7NEo fw%,eeM, Alternate Phone#: �ro -a30- Designated Alternate 1: RM., 0_?.,oe&„k•1 Designated Alternate2 Restaurant Owner Contact Information Owner's Name: &�{j�� e'. Street Address: f� AZ City, State, Zip Code: Phone#: ,p, t ,� Q Fax #: E-Mail Address G9'�TaL7 ;�1�tea<a � Cell Phone#: Renovations Were there any renovations made last year? YES❑ NO in Will there be any renovations? YES❑ NO J] If Yes, please list all renovations that were done/to be done: Mailing Address to send Food License Renewal Permit to: Name of Restaurant/Company: N'mr Attention: Aa /-?1*6L _ -mow Address: '7no �' 9 A/ 1�-a _ r_IVr_w City, State, Zip Code: SSOGkl Wjf. Ceti C4-- 060 7`1 -„f%41 Phone#: U� y3� cP NOV 6 u L.V I SOUTH"NDSOR HEALTH DEPT. Restaurant Menu/List of All Items Served/Sold Latest Menu Attached? YES C9 NO ❑ NOTE""(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: ZPublic Private Well Wastewater Disposal: P"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): Applicant Signature: Date: Office Use Only Inspector Name (Print): Inspector Signature: � � Date: U _i2I �gI« Food Class: 1 ❑ 2 ❑ 3 N�T 4 ❑ Expiration Date: �Z( i I1 Date Received: Date Approved: 12, 1 ( l 1 ` ''l I �,� (WC- - Certificate#14086404 Safe Issued 9/612016 ServSafe, CERTIFICATION Name: DANIEL BELL Expires 9/6/2021 Certificate#14086405 Safe—, Issued 902016 ServSafe CERTIFICATION Name: RONALD BROOKS Expires �i6/2021 1%01W T11E 6PJLL BAftBECUE SEAFOOD Comes with your choice of 3 sides, cornbread Choose from One Meat—$15.95/person and Watermelon Two Meats—$18.95/person or z Texan Fish Fry Belly Buster (Three Meats)-- - 2V' person A� . ; Grilled Chicken Breast _ - . Fried Catfish -or- Cod Pulled Pork—or— Pulled Chicken $12.95/person _ Served with: NY Strip Steak Your Choice of 3 Sides Fries, Coleslaw, and hush puppies p p pP Including Cornbread and Watermelon $15.95/person $14.95/person Cowboy Rib-eye All of the following come with cornbread and melon 95 Clam Bake $22. /person ,r Babyo§aek Ribs Lobster and NY Strip & Grilled Chicken Combo (+$1. /person) �j Your Choice of 3 sides $19.95/person Grilled Clams -or- Mussels ' Barbecue Chicken Served with: ic ic Your Choice of 3 sides Dinner Rolls, Corn and Potatoes Beef Brisket '- Available Sliced or Pulled ( Additional Seafood Upon Request Texas Spud Me Your Choice of 3 sides As seen at a LMS $24. /person (price subject to change) Build Your Own: Smoked Sausage butter, sour creamcheese, bacon, chive Your Choice of 3 sides $6. /person - . _„zy— With PulleA Pork—or- Chili $9. /person BBQ Spare Ribs Fresh Grilled Fish T Your Choice of 3 sides Sandwiches Burgers & Dogs Combo Salmon, Black Sea Bass, Tuna —or—Sword Pulled Pork—or—Chicken Served with: Potato Salad, BBQ Beef Ribs Other Fish Upon Request Also Available as a Combo Coleslaw, and Chips 95 Served with: Dinner Rolls, Steamed Veggies, Served with: Potato Sal- $18. /person as one meat - $10.95/person and Mashed Potatoes ad, Coleslaw, and Chip Burgers'and Additional meat for an extra cost and Dogs can be - so available as sliders added to any Meal for $27.95/person (price Subject to Change) Al Your Choice of 3 sides � ,� c� $1095 /perSOn additional $3.99/person - ��, jr_. -,; - ;�� _f✓��i, AVAn,A0 SIDES ABOUT OUR CATWN6 SERVICES ,� a� DatuW6 (Your Choice of Three Unless Specified Otherwise) OPTION#1— PICK UP We will have your entire events food * Pork-n-beans Grilled Veggies ready for you to pick up in serving trays with plastic ware, * Potato Salad Corn on the Cob plates and napkins. VILE TAS OPTION#2—DELIVERY OPTIO N We will come to the site of r * Cole Slaw * Pasta Salad your event and drop off the food including plastic ware, O F * Mexican Rice - Salad Greens napkins and plates. Call for charge. OPTION#3— DELIVERY SET UP We send our crew out to the TEXAS * Refried Beans Mashed Potatoes event site, set up your entire events meal,tables,table * Steamed Veggies * Mac and Cheese clothes, chaffing dishes, all set ups. We then leave and come back at the end to clean up. Just bring the appetite! CATERING MENU ALJPJPMJ= $150.00 plus time and travel Optional On-site Cook and Server Available (Prices Available upon Request) Drums-n-Flappers (wings) * Mini Tacos Hosting an event, having a social gathering, �;t�i1CK .�.C�QN �Q-DOW1V C.t�TERMCx SERVICE * Quesadilla Roll-ups -r Jalapeno Poppers We will come to the site of your event and set up tables and graduation, family reunion or an office party? Nuggets Chicken Nu * chaffing dishes for food. We have staff there for the duration * gg Mini Corn Dogs of your event there to do whatever we can to make your day Planning a Wedding, Bachelor Party, Jack and Jill Chili Con Queso * Corn Fritters easy. We cook all special catering options on site. We supply or Birthday party? * all condiments, plates, napkins and plastic ware. Chuck Wagon Ho-down also includes karaoke, calf-roping and music. At the AFtT� p g Why not let us take the stress out of your spe- end of the event our staff promptly cleans up before we leave. Deep Fried Twinkles-or-Oreos $4.99 /person $499.99 cial day! Choose from party trays, family packs, =* With Whipped Cream, Ice Cream &Chocolate Sauce or catering by our on-site Chuck Wagon. Chocolate Lava Cakes IZ� $4."/person Peach Cobbler $3. /person� 9e Any and All of our Catering Foods and Services� can be adjusted to meet your events needs. 1750 Ellington Rd Bld#2 Assorted Brownies & Cookies $3.99/person South Windsor CT 06074 Tel: (860) 436-1232 Fax: (860) 436-1233 (Unlimited) '� � ( l �' = For morc information can cnu•Catering Serviccs Visit our website: Iced Tea and Lemonade Bottled Water and Served with your choice of 3 sides including www.dannyslittictastcoftcxas.com Mixed Soda cornbread and watermelon $2 00/person Or send us an c-mail: so Minimup 50 people ltot cLltot.nccoxmail.com Coffee &Tea $3.99/person $2• /person P $18. /person 416 Cr��^