Licenses TOWN OF YARMOUTH
BOARD OF HEALTH
PERNIIT TO OPERATE A FOOD ESTABLISIIMENT
� � PERMIT NUMBER: #10.124 FEE: 85.00
In accbrdance witlt re�etions promulga[ed under authority of Chapter 94,Section 305A and C6ap[er
11 l,Section 5 of the eneral Lsws,a permit is hereby granted to:
A.M. P;��,a Inc., 23T Wirite's Path, South Yarmouth, MA
Whose place of business is: Domino's Pizza
Type of business: Food Service
To operate a food establishment in: Town of Yarmouth
Permit expires: December 31. 2010 BOARD oF HEALTTI: �riart�!l�inta�Stn�itM, C�1lai+rntan
SEAiAlG: O J (It�A�llQl9/�� V(C6 C��QlNBIQIL
2EslRtciioxs: See Reverse Side. ZIIQ�I(Cl'qflK C. SK6llfl�¢JE III� �PJC�
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Febmary 23.2010 '
Bmce G.Murphy,MP . .,CHO
Director of Health
•RESTRICTIONS:
1. No&yers.
2. No dishwasher machine.
3. No c(othes washer machine.
4. No seats-take out only. ' • .
5. No stove-pizza oven only.
6. Sipgle service/paper items only.
7. Separate water meter,for thLc umt 23T required.
8. All pizza ingredients aze to be obtained as precooked.
9. Ma�umum daily water usa�e not to excced 175 gpd;A montlily log is to be maintained
with a yeady repore submrtted co the Health Department by December 1 of every yeaz.
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