HomeMy WebLinkAbout2017-11-30 - 1750-2 Ellington Road - Food Permit Application Town of South Windsor- Health Department
Y 1540 Sullivan Ave., South Windsor, CT 06074—Mailing Address
1530 Sullivan Avenue, South Windsor, CT 06074—Office Address
yA, Phone Number: (860) 337-6173 Fax: (860) 644-1930
1'SOR•Co
Restaurant Establishment Information New Permit❑ Permit Renewal MP
A*I*'*(Pleasee Print Clearly)***
ter
Name of Establishment: C/ 1►��y//j L���� ��J �� � ���
Manager's Name:
Street Address:
City, State, Zip Code: �11
b �
Phone#: l��� qG� — Cell Phone#: mod690- 919A0
Fax#:
E-Mail Address: Mro0_4r1*1X0;C^t11 Seating Capacity:
Please submit latest copy of the Qualified Foodld�90or/ServSafe certificates to the office.
Qualified Food Operator: YES® NO ❑ (Required for Certificate#:
class 3&4) �G yo y
Name: ,�p�y !r Date: Az/6
Testing Organization: _ te^A( 44f Phone#: 0-{f 3�•9�
E-Mail Address: J.Wo4*7 /E4fwi�� Alternate Phone#: 9-6p —aIU- �f q00
Designated Alternate 1: /� �jmn�1 Designated Alternate2 : ZU, 7;VyAr* J
Restaurant Owner Contact Information
Owner's Name: &w jir e,6-eC
Street Address: z2s-
City, State, Zip Code: : t ®�40
CW
Phone#: , Q Fax #:
E-Mail Address: Gp►dT�/ �� Cell Phone#:
Renovations
Were there any renovations made last year? YES❑ NO in Will there be any renovations? YES❑ NO �]
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: ,04w 0
Attention:
Address:
City, State, Zip Code: Spat C — 0(0 0 7`1
Phone#: 0 q q NO Q 2�17
S HF-A�H DEP
i OR
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 a copy of a menu attached is applicable.
Additional Information
Please check one only:
State Licenses: ❑ Bakery ❑ Liquor Permit None
Water Supply: ZPublic PrivateWell
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): A
Applicant Signature: v(/ Date:
Office Use Only
Inspector Name (Print):
Inspector Signatur`e:,l I Date:
Food Class: 1 ❑ 2 ❑ 3 4 ❑ Expiration Date:
Date Received: Date Approved: 12 1 ( l 1
�'n l 1� n� Cw(,L 4
-------------------
Certificate#14086404
Safe Issued 9/612016
ServSafe
CERTIFICATION
Name: DANIEL BELL
Expires 9/6/2021
-- -- -- ------------------------- --
Certificate#14086405
Safe Issued 902016 i
ServSafe'
CERTIFICATION
Name: RONALD BROOKS
Expires 9/6/20211 ",,,
M
IWOM THE fifULL BAftBECUE SEA]FOOD
41 Comes with your choice of 3 sides, cornbread Choose from One Meat—$15.95/person
95
`- and Watermelon Two Meats—$18. /perso 9or �� Texan Fish Fry fi�i r
Belly Buster (Three Meats),$21. /person s
Grilled Chicken Breast - —
--� Fried Catfish -or- Cod
�_3
Pulled Pork—or— Pulled Chicken
$12.95/person -11 Served with: �I
NY Strip Steak - Your Choice of 3 Sides ' pupp
ies
Fries, Coleslaw, and hush u ies
Including Cornbread and Watermelon
$15.95/person __ $14.95/person
Cowboy Rib-eye All of the following come with cornbread and melon 7
95 Clam Bake
$22. /person ( ,
Baby�ack Ribs I j Lobster and f �
NY Strip & Grilled Chicken Combo (+$1. /person)
�j Your Choice of 3 sides �j I `�_ .. � ?
$19.95/person Grilled Clams -or- Mussels
Barbecue Chicken Served with:
CLMSIC ic Your Choice of 3 sides �
Dinner Rolls, Corn and Potatoes
fi r-�---r �-- Beef Brisket
'- Available Sliced or Pulled ( Additional Seafood Upon Request
Texas Spud Mea Your Choice of 3 sides
As seen at
0 $24. /perSOn (pace subject to change)
Build Your Own: Smoked Sausage
butter, sour creamcheese, bacon, chive Your Choice of 3 sides
$6. /person
With PulleA Pork—or- Chili
$9. /person BBQ Spare Ribs Fresh Grilled Fish
Your Choice of 3 sides
Sandwiches Burgers & Dogs Combo Salmon, Black Sea Bass, Tuna —or—Sword
Other Fish Upon Request
Pulled Pork—or—Chicken Served with: Potato Salad, BBQ Beef Ribs =- P q
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 Dogs can be Additional meat for an extra cost
$27.95/person (price Subject to Change) /
Also available as sliders added to any Meal for Your Choice of 3 sides r� 1
1095 / erson additional $3.99/person ;._ ��, �,; _ - ✓ �'
$ P
AVAn,A0 SIDES ABOUT OUR CATWN6 SERVICES �. ��� DatuW6 ,,Cl w14,r
r,., „
(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 plates and napkins.
Corn on the Cob >,-VILE TAS '
OPTION#2—DELIVERY OPTION We will come to the site of
Cole Slaw Pasta Salad your event and drop off the food including plastic ware, OF
Mexican Rice
: Y 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
]P]P��� $150s plus time and travel
f t 55 Optional On-site Cook and Server Available
(Prices Available upon Request)
Drums-n-Flappers (Wings) Mini Tacos Hosting an event, having a social gathering,
CHUCK A(aON 110-DOWN CATERM(a SERVICE
Quesad ilia Roll-ups '--- * Jalapeno Poppers We will come to the site of your event and set up tables and graduation, family reunion or an office party?
Chicken Nuggets Mini Corn Dogs chaffing dishes for food. We have staff there for the duration
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
end of the event our staff promptly cleans u before we leave. Why not let US take the stress out Of your spe-
Deep Fried Twinkles-or-Oreos $4.99 /person p$q.gg,99 p cial day! Choose from party trays, family packs,
� With Whipped Cream, Ice Cream &Chocolate Sauce
Chocolate Lava Cakes $4.99/person or catering by our on-site Chuck Wagon.
$3.
Peach Cobbler � 9e/person
Any and All of our Catering Foods and Services
��
can be adjusted to meet your events needs. ton Rd Bld#2
Assorted Brownies & Cookies $3.99/person 1750 Ellin South Windsor CT 06074
in Tel: (860) 436-1232
Fax: (860) 436-1233
(Unlimited) ��`�' � ( For morc information can oLir 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 scna us an c-mail:
so Minimup 50 people ltot cLltot.nccoxmail.com
Coffee &Tea $3.99/person $2• /person $18. /person