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Home My WebLink About948 Sullivan Avenue 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 �tOSoe•c�` Establishment Information New Permit❑ Permit Renewal Type: Mobile/Itinerant Vendor❑ Temporary Event❑ Permanent Food Service/Establishment❑ ***(Please Print Clearly)*** CLASS: 1 FEE DUE: 75 Name of Establishment: Happy's Nutrition Name of Person in Charge: Establishment Street Address: 948 Sullivan Ave City, State, Zip Code: South Windsor, CT 06074 Phone#: Cell Phone#: Fax#: E-Mail Address: Seating Capacity: Please submit latest copy of the Certified Food Protection Manager/ServSafe certificates to the office. Certified Food Protection Manager YES❑ NO ❑ Certificate#: (CFPM) (Required for ALL Class 2,3&4) Name: Expiration Date: Testing Organization: Phone#: E-Mail Address: Alternate Phone#: Alternate Person In Charge Phone#: Restaurant Owner Contact Information n �` - Owner's Name: Dreit F,,�kV l �" '5 ry , tatL,e check one of the following for ownership k� status: Mailing Address: 1i10d&j,e �� Individual ❑El ❑ Corporation Partnership City, State, Zip Code: l ❑ L�C1 r` W 1 r 1 C 0( O7�J Other Legal Entity❑ ��G Phone#: 7Zq — z C�i Fax #: E-Mail Address: (,�-p(jj� @qJ.�Q(,f/1 Cell Phone#: PQ 51e-dS:9-3-90 71 Renovations Were there any renovations made last year? YES❑ NO Will there be any renovations? YES❑ NO� If Yes, please list all renovations /— that were done/to be done: Restaurant Menu/List of All Items Served/Sold Latest Menu Attached? YES/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. Restaurant Food Prep (check all that apply) ❑ Cook to order ONLY ❑Advanced catering for specific quantities ❑ Uses Time as a Public Health Control ❑ Cooking/cooling/reheating/thawing/freezing/hot or cold holding ❑ Prepares food to serve at another site ❑ Prepares food for Highly Susceptible Population(preschoolers or the elderly) ❑ Prepackaged non TCS Food Only ❑ Non TCS Food only(food that does not require refrigeration) Additional Information Please check all that apply: State Licenses: ❑ Bakery ❑ Liquor Permit ❑ None Water Supply (check only one): _ Public _ Private Well Wastewater Disposal (check only one): _ Public _Septic _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 and that I will comply with the ordinances and regulations of the Town of South Windsor and State of Connecticut. I also affirm to allow the Town of South Windsor Health Department access to the establishment as required. 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): Date of Birth: Applicant Address: L(�hQ ` u (,c'I L Phone#: Applicant Signature: Date: c(, Office Use Only Inspector Name (Print): Inspector Signature: Date: Food Class: Expiration Date: Date Received: Date Approved: Banana Split Caff mocha 2 Chocolate PDM 2 Chocolate PDM SMOOTHIE RECIPES!!! 1 Banana Caramel Fl 2 Cafe latte F1 1 French Vanilla F1 Apple Peanut Captain Crunch 2 Peanut Cookie PDM Bit-0-Honey 1 Vanilla PDM 2 French Vanilla F1 1 Vanilla PDM 1 Peanut Cookie PDM 1 scoop Apple fiber 1 Peanut Cookie PDM 2 Wild Berry F1 1 Dulce de leche F1 Blueberry Apple Pie 1 French vanilla F1 2 vanilla PDM Caramel Macchiato 1 French Vanilla F1 2 Vanilla PDM 1 Dulce de leche F1 Blueberry Muffin 1 Dulce De Leche F1 1 scoop Apple Fiber 2 Vanilla PDM 1 Cafe latte F1 Cinnamon (pinch) 2 French Vanilla Fl Caramel Blueberry Bahama Breeze Caramel Spice 2 Vanilla PDM 2 Vanilla PDM 1 Pina Colada F1 Butterfinger 2 Cafe Latte F1 1 Orange Cream F1 1 chocolate PDM Cinnamon 1 Peanut Cookie PDM Caramel Banana Fosters 1 Cookies and Cream Fl 2 Vanilla PDM 1 Dulce De Leche F1 Cheesecake 2 Banana Caramel Fl Butterscotch 2 Vanilla PDM 1 scoop PB2 2 French Vanilla Fl Cafe Latte Frappe Cheesecake Banana Nut Bread 2 Vanilla PDM 2 Vanilla PDM 2 Cafe Latte Fl Chocolate Peanut 2 Banana Caramel Fl 2 Peanut Cookie PDM Cinnamon 2 Dutch Chocolate F1 Chunky Monkey Double Chocolate 2 Chocolate PDM 2 Chocolate PDM 2 Banana Caramel Fl 2 Dutch Chocolate F1 PB2 Chocolate chips Jamocha Macchiato 1 Vanilla PDM Cinnamon Roll Double Cookie 1 Chocolate PDM 2 Vanilla PDM 2 Peanut cookie PDM 1 Dulce De Leche F1 2 Cookies & Cream F1 2 Cookies&Cream F1 1 Cafe Latte F1 Butterscotch Butterscotch Cinnamon Dreamsicle 2 Vanilla PDM Key Lime Cinnamon Toast 2 Dulce De Leche Fl 2 Vanilla PDM Cheesecake 2 French Vanilla Fl 2 Vanilla PDM Dulce De Leche Lime L/0 2 Dulce de Leche Fl 2 Vanilla PDM Cinnamon 2 Dulce De leche Fl Lemonade Cheesecake 2 Vanilla PDM Salt Frosted Animal Cookie 1 French Vanilla F1 2 Vanilla PDM 1 Cookies&Cream Fl Cookie Dough 1 Cookies&Cream F1 Lemonade 1 Vanilla PDM 1 French Vanilla F1 1 Peanut cookie PDM White Chocolate Maple Long John 2 Cookie& Cream F1 2 Vanilla PDM Choco Cream Cookies Fruity Pebbles 1 Dulce De Leche Fl 1 Vanilla PDM 1 French Vanilla F1 Cookies &Cream 1 Peanut Cookie PDM Maple 2 Vanilla PDM 2 Orange Cream F1 2 Cookies&Cream F1 Blueberry Mint Chocolate 2 Vanilla PDM 2 Mint Chocolate Fl Peanut Butter Waffle Orange Cream 2 Peanut Cookie PDM 2 Vanilla PDM 1 Dulce De Leche F Mint Oreo 2 Orange Cream Fl 1 French Vanilla Fl 2 Vanilla PDM Maple 1 Mint Chocolate Fl Orange Scone 1 Cookies & Cream F1 1 Chocolate PDM Peanut Oatmeal Cookie White Chocolate 1 Vanilla PDM 2 Peanut Cookie PDM 2 Orange Cream F1 2 Cookies&Cream F1 Mochaccino Cinnamon Cinnamon 2 Chocolate PDM White Chocolate 2 Cafe Latte Fl Pina Colada PayDay 2 Vanilla PDM Mudslide Muscle Man 2 Peanut Cookie PDM 2 Pina Colada F1 (PostWorkout) 2 Dulce De Leche Fl 2 Rebuild Strength Peanuts Puppy Chow 1 Cookies&Cream F1 2 Chocolate PDM 1 Dulce PB&J 2 Mint Chocolate Fl PB2 2 Vanilla PDM PB2 2 Wild Berry Vanilla F1 White Chocolate PB2 No Bake Cookie Red Brick 2 Chocolate PDM 2 Chocolate PDM 2 Cookies&Cream F1 Peanut Butter Cup 2 Cookies&Cream F1 PB2 1 Peanut Cookie PDM White Chocolate 1 Chocolate PDM Red Velvet Oatmeal Cookie 2 Dutch Chocolate 2 Vanilla PDM PB2 2 Cookies&Cream Fl Cinnamon Roasted Peanut Latte Strawberry Banana Wedding Cake 2 Peanut Cookie PDM 2 Vanilla PDM 1 Banana 2 Vanilla PDM 2 Cafe Latte Fl Caramel F1 2 Cookies & Cream F1 1 Wild Berry Fl Cheesecake Salted Caramel Cheesecake White Chocolate 2 Vanilla PDM 2 Dulce de Leckie Strawberry Cheesecake White Chocolate Reesez Caramel 2 Vanilla PDM 2 Peanut Cookie PDM Salt 1 French Vanilla Fl 1 Cookies&Cream F1 1 Wild Berry F1 1 French Vanilla Fl Sa watch Cheesecake PB2 sq 2 Peanut Cookie PDM White Chocolate 1 Cookies&Cream Fl Strawberry Orange Banana SOB l Dulce De Leche F1 2 Vanilla PDM Wild Berry Butterscotch 2 Vanilla PDM 1 Orange Cream F1 PB2 2 Wild Berry F1 1/2 Wild Berry F1 Suickerdoudle 0 Banana Fl X's & O's 1 Vanilla PDM Thin Mint 2 Chocolate PDM 1 Peanut Cookie PDM 2 Wild Berry Fl 1 Cookies&Cream Fl 1 2 Chocolate PDM 2 Mint Chocolate Red Velvet Dulce De Leche Fl Cinnamon Turtle Cheesecake Vegan Sniekerz 1 Vanilla PDM 1 4 Allergen free Chocolate PDM PB2 2 Chocolate PDM 1 Cookies&Cream Fl Cinnamon 1 Cookies&Cream F1 1 Dulce de Leckie Fl 1 Dulce De Leckie F1 Cheesecake Caramel BOOSTED TEA RECIPES Beauty&the Beast Mode Sour Patch Tea Skittlez Tea Beauty Collagen Tea NRG NRG Orange LO Lime LO Tropical L/O Aloe Aloe Aloe Skittlez Skittlez Water or Skittlez Orange The Hawaiian Cherry Limeade The Bobcat Tea Tea NRG Sunrise NRG Orange LO Tea Tropical LO Aloe Pomberry LO Aloe Pineapple Aloe Snozberry (Acai) Pineapple Pom Pom The Grand Slam Tea The Hall Of Famer Tea Pomberry LO Tea NRG Aloe NRG Lime LO Pomberry Pomberry LO Aloe Aloe Strawberry Strawberry Festival Watermelon Lemonade Tea NRG Tiger Bomb Captain America Tropical LO Tea Tea Aloe NRG NRG Strawberry Orange LO Pomberry LO Aloe Aloe Berry Happy Cherry Limeade Blue Raspberry Tea Pomberry LO Jersey Shore The Farmer Aloe Tea Tea Strawberry Lime L/O Lime L/O Orange Aloe Aloe Tropical Punch Green Apple Sp BOOSTED TEA RECIPES Platinum Mega Super Tea Any Flavor -pick a flavor from the dozen! add: Tea, NRG LO - choose flavor Beauty Collagen Aloe The Dozen Blue Raspberry Blue Blast Ultimate Experience Cherry Limeade Tea Grape HAPPY ALL OVER Lemonade Tea Orange Crush Beauty Collagen Pineapple NRG Skittlez Tropical L/O Acai Berry Aloe Strawberry Skittlez Green Apple and Tropical Punch Served with a fat- Watermelon burning powdered donut shot* on the side! *PROLESSA with ALL INGREDIENTS IN sugar free caramel BOLD TYPE ARE an UPCHARGE syrup ADDED TO EACH CONSUMPTION