Environmental Health Section 98 E. Morgan St., Brevard, NC x243 Fax:

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1 Environmental Health Section 98 E. Morgan St., Brevard, NC x243 Fax: FOOD SERVICE PLAN REVIEW APPLICATION Must be submitted at least 30 days prior to planned opening date or expiration of current owner s permit NEW REMODEL CHANGE OF OWNERSHIP Projected Date for Start of Construction Projected Date for Completion of Project Receipt # Date Rec d Name of Establishment Is the establishment: Stationary OR Mobile AND Permanent OR Temporary Physical Location Zip Code Complete Mailing Address Zip Code Telephone : Fax: Address: Applicant's Name Mailing Address (if not already given above) Home: Work: Mobile: Address: Proposed Permit Holder Please specify. Is this an individual, association, partnership, LLC, corporation or other legal entity? Complete Mailing Address Zip Code _ Home: Work: Mobile: Address: Current Permit Holder Complete Mailing Address Zip Code Home: Work: Mobile: Address: Contractor Mailing Address Zip Code Home: Work: Mobile: Address: Architect or Engineer Mailing Address Zip Code Home: Work: Mobile: Address: Payment of $250 must be enclosed with this application: check payable totransylvania County, cash in person, OR payment by Master Card, Visa, AME, or Discover. Please see attached sheets for submission details. On-line Construction guidelines: On-line Rules: On-line information is available:

2 Transylvania County FOOD SERVICE PLAN REVIEW APPLICATION Page 2 Establishment Name: The following information must accompany this application: A complete set of plans, drawn to scale, showing the location of equipment, plumbing. electrical and mechanical details, and construction finishes must accompany this application. SITE PLAN Provide a site plan that identifies the location of: the dumpster pad, municipal or private water and sewer lines, any drinking water well locations, and any outbuildings. REQUIRED SCHEDULES Plumbing details must include any hot water generating equipment specifications and locations, riser diagrams for both water and sewer/wastewater, positioning of required floor drains, floor sinks, and trench drains. Mechanical plans should include construction, installation and placement of cooking and restroom exhausts. An accurately scaled reflected ceiling plan specifying the type and placement of ceiling tiles and lighting fixtures is required. Complete the included finish schedule (see page 4) or provide a finish schedule on the plans which indicate the material, composition and placement of approved floor, wall and ceiling applications within all food service areas. FACILITY PLAN Provide a scaled equipment floor plan (1/4 inch=1 foot preferred) that details the placement and type of equipment. Interior and exterior seating plans must be included and any designated customer smoking areas must be identified. EQUIPMENT DETAILS A food service equipment list (one provided on page 5 or may be provided on the submitted plans) must include the equipment item name, manufacturer and model number for all equipment. Providing manufacturer equipment cut sheets will decrease the time for plan review response. MENU An accurate listing of all food and drink menu items that will be offered must be provided. The plan review process not only reviews the physical construction of an establishment but the receiving, storage, preparation, service and cleaning procedures. (See pages 6-8.) You must designate the level of service you will provide including the type of dining utensils that will be offered to the customer during the service process, i.e., reusable and/or single-use (disposable), and the number of customers you project to be served at each meal (see page 4). In addition to the Health Department, the following agencies must be contacted. Building Permitting & Enforcement Mike Owen, Chief Fire Marshall Gerald Grose x5 Planning and Zoning (County) Mark Burrows City of Brevard Planning/Licensing Daniel Cobb County Finance Office (Room Occupancy Tax-Lodging Only) Deanna Medford x 113

3 Transylvania County FOOD SERVICE PLAN REVIEW APPLICATION Page 3 PLUMBING Water Supply and Sewage: 1. Is water supply: Community Well Is sewer: Municipal Septic 2. Will ice: be made on premises or purchased Where? Handwashing Indicate number and location of food service hand sinks: Dishwashing Manual Dishwashing (required) Bowl Size: L x W x D Number of compartments: Length of drainboards: Sanitizer: Chlorine (bleach) Quaternary Ammonium Hot Water Other? Mechanical Dishwashing: If a dishmachine will be used, please indicate: Dishmachine manufacturer Model Number: Type of sanitization: Hot water (180 o F) Constant Temp (165 o F) Chemical (50 ppm Chlorine) Describe how cooking equipment, cutting boards, slicers, counter tops and other food contact surfaces that cannot be submerged in sinks or put through a dishmachine will be cleaned and sanitized: Describe location and type (drainboards, wall-mounted or overhead shelves, stationary or portable racks) of air drying space: Mop and Trash Can Cleaning Facilities: Location and size of can wash/mop storage area If a separate mop basin is provided, describe type and location: HOT WATER: Information on Proposed (or existing) Hot Water Heater (s) GAS: Btu rating ELECTRIC: kw rating Gallons of storage: Gallons of storage: Efficiency of unit (%): (If not specified, 76% will be used) TANKLESS: Manufacturer and Model #: Rating: GPM at o F rise Number of units to be used:

4 Transylvania County FOOD SERVICE PLAN REVIEW APPLICATION Page 4 FINISH SCHEDULE Applicants must fill in materials (i.e., quarry tile, stainless steel, 6" plastic coved molding, etc.) Finish schedule does not need to be completed if included on blueprints/plans. AREA FLOOR BASEBOARD/ Floor-to-Wall Kitchen Food Storage Other Storage Waitstaff Station Bar Restrooms Dressing Rooms Mop/Can Wash Garbage & Refuse Other WALLS CEILING FOOD SERVICE Facilities and Processes PLANNED SERVICE Number of Staff (maximum per shift) Total Square Footage of Facility Number of Dining Room Seats Number of Outdoor Seats Projected Number of Meals to be Served at Breakfast Lunch Dinner TYPES OF SERVICE (check all that apply) Restaurant Multi-Use Utensils Commissary Tableware Meat Market Glassware Sit Down Meals Silverware Take Out Single-use Utensils Catering Tableware Push Cart Glassware Mobile Food Unit Silverware Limited Food Service Additional Information Non-PH Foods only Prepare only to order Prepare in advance & to order Package Foods onsite HOURS OF OPERATION Sunday to Monday to Tuesday to Wednesday to Thursday to Friday to Saturday to

5 Transylvania County FOOD SERVICE PLAN REVIEW APPLICATION Page 5 No. on Floor Plan Example: 1 Equipment Item Manufacturer s Name Model No. Manufacturer Spec Sheet Provided Convection Oven American Range Corp Used or New? NSF Listed? M-1-GG Yes New Yes Failure to provide Cut Sheets (Manufacturer s Specification Sheets) may delay approval.

6 Transylvania County FOOD SERVICE PLAN REVIEW APPLICATION Page 6 SPECIALIZED PROCESSES: Indicate any specialized processes that will take place. You must submit an application for a Variance and/or a HACCP plan for these operations. Food Additives for preservation or to render food non-tcs Curing Smoking (eg: acidification of rice for sushi) Sprouting Beans Other Food Additives to render food non-tcs Reduced Oxygen Packaging (eg: Vacuum) Explain any checked processes: Indicate any of the following highly susceptible populations that will be catered or served: Nursing Home Child Care Center Health Care Facility Assisted Living Center School with pre-school aged children COLD STORAGE Refrigeration Capacity Reach-in Refrigeration Walk-in Refrigeration Number of reach-in refrigeration units Number of walk-in refrigeration units Total cubic feet of reach-in refrigerated units Total cubic feet of walk-in refrigeration units Total cubic feet of reach-in freezer units Total cubic feet of walk-in freezer units COLD HOLDING Please list all foods that will be held cold: HOT HOLDING Please list all foods that will be held hot: COOLING Indicate by checking the appropriate boxes how cooked food will be cooled to 45 0 F (7 0 C) or 41 0 F/5 0 Cwithin 6 hours. If Other is checked indicate type of food. Cooling Process Meat Seafood Poultry Other Type Food Shallow Pans Ice Baths Rapid Chill THAWING Indicate by checking the appropriate boxes how food in each category will be thawed. If Other is checked indicate type of food. Thawing Process Meat Seafood Poultry Other Type Food Refrigeration Running Water less than 70 0 F Cooked Frozen Microwave (cooked immediately)

7 Transylvania County FOOD SERVICE PLAN REVIEW APPLICATION Page 7 FOOD HANDLING PROCEDURES Explain the following with as much detail as possible. Provide descriptions of the specific areas of the kitchen and corresponding items on the plan where food will be handled. Describe the process from receiving to service. 1. READY-TO-EAT FOOD HANDLING (edible without additional preparation necessary, e.g., salads, cold sandwiches, raw molluscan shellfish, cooked and cooled foods, cured/dried meats) How the food will arrive (frozen, fresh, packaged, etc.) How will bare-hand contact with RTE foods be avoided? 2. PRODUCE HANDLING How the food will arrive (frozen, fresh, packaged, etc.) 3. POULTRY HANDLING How the food will arrive (frozen, fresh, packaged, etc.)

8 Transylvania County FOOD SERVICE PLAN REVIEW APPLICATION Page 8 4. MEAT HANDLING How the food will arrive (frozen, fresh, packaged, etc.) 5. SEAFOOD HANDLING How the food will arrive (frozen, fresh, packaged, etc.) DRY STORAGE Where will dry goods be stored? Shelving Unit Location # of units # of shelves per unit Width of shelf in feet Depth of shelf in feet Space between shelves in ft. EMPLOYEE AREA Indicate location for storing employees personal items: Indicate location for employee breaks Location of chemical storage

9 Transylvania County FOOD SERVICE PLAN REVIEW APPLICATION Page 9 GARBAGE AND REFUSE 1. Will refuse be stored inside? Yes No If yes, where 2. Outside garbage storage: Dumpster Compacting dumpster Trash Cans 3. Surface where garbage will be stored (asphalt drive, concrete pad, etc.) 4. Provision for cleaning dumpster/compactor: On-site Off-site If off-site cleaning, provide name of cleaning contractor. Contract must be available prior to permitting. 5. Describe location for storage of recyclables: (cooking grease, cardboard, glass, etc.) INSECT AND RODENT Control 1. How is fly protection provided on all outside doors? Self-closing door Fly Fan Screen Door Other (describe) 2. How is fly protection provided on windows? Self-closing Fly Fan Screening Other (describe) 3. Location of insecticide/rodenticide storage: 4. Location of clean linen storage: 5. Location of dirty linen storage: SIGNATURES: Date Completed Applicant s Signature FOR CHANGE OF OWNERSHIP ONLY: New Permit Holder (Corporate Name, Individual Owner s Name, Etc.) Mailing Address Present owner must sign: I hereby grant the above applicant and the Transylvania County Health Department permission to conduct an evaluation for the purpose of identifying non-compliant items at. I understand that no permit can be issued to the applicant until legal transfer of ownership and/or execution of a valid lease has occurred. Date Owner's Signature