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i 7"OWN t?�YAFtMtIUTF��O:ARD Cfk HEAI.TI� APPLiC'ATlON FURLICENSE>/PER1t3I7"-2tI1"7 - * k'le�.���lur�e�tac�rc�}so�da�tac�h nth�returnc�yr�ur�appl�s�tton.pack�t.���p16. � � ,r ,� e.� y. . � �s r���.��r��ra�r�����: � ��.��� � ���- � �«t.s�: ��--� � �� :�` ��~ �.�c.a�t�����r�.[at��t��,�,5. 1 �"� ��s� �..�,��,�3 p r�.� ��:��� µ�. �a�t.t�c�n�t7�.cs5 > ' V �`` '� � � ,�:�:..�..�� __.._ .�___. �___ .._.._�___ .._..�........� f�-R�IAi1,�l�DTt��S� '� i,...� � �w, C'>W'Vi�Ci Ivt�twlE: . ° .... � (:`t1C21'{?ItA"i'[()Pd'f�I�.ME:(TFAPf'LiCAI3I..Fs): � t9��r$ t"` 5�''��i'�'`..�� s:3���"�%� �,L�C... � � '� � � I i't # :` �--� t�,��r�c���.��s ra�:�c; , x, e��°,,��.._.._,�..��.�;���-- ,. M�11.�T?�f,tlt.)tJ725iSS: �?.. � �'���l�"�:r i L� '�' �� ��t� L`�t1`� ��'.�v�. ��� � 1'OC)LCf�';ttl'!i'It;A"I`.t(�I�t',�': '.�, �� �� � The poal sapervisvr m�st be cert�ifiecf�s a Pov!Uper�tar,as reqnired by S#ate law. F'l�u:;e Iist th�:�ietiigaated I'cxil t�cr�itor(s?anrl attach a cc�py c>4 thc cct�tifi��tit�n tc>thls f'r�rm. � � �, �._ ..�____ . __ M — L � . _�.___..... _ r I'csul c�pt;raiars must l�st a minamum e�f twt�em�tayez's cum�tl}=c.'erti�e:cl in staYacl:�rd X�lr:�t Atci rnti C ommuni[� iJi � � , Cardicrpulmc�nar�2t�suscitatic�n(CPR),having flt�e ceztifi�ezt�ployee on�Sr�mis��:s at all�imc4. Plc.ase hwt thc, _ O � �;n�nloy�c�i�clrrw nrtd�tkach co(ries c�f thei�certafic�€ic�ns to thi�1't�tsn.'Che�leaitl�Dep�rt�nenC cwilt not us�e p�st _{ ��eurs'recor�is. Yuu mu�t�rovide new c+�pies and maintuFn s#�ie�t yogr pl�ce of business. (-� G� . '1 .�..,...._T.._.. ��..-_....�.��.... ��',� Q ...._........---•----'-. ��,.._�.. .,.J � q. .. i �...W � �, , ..�---' ff:"� '� ����f� �-..........--�.--.•.•..--^.^ . . . � �r�e;�[�tc�z���;*�nz,l.�s-c�s���r�r=rr:�7�ic��s: t'�,��--- �� ��:�<���xc� Aii fi�od se;rt=iec;establishm�:nts�€tre r�;yuir�d t�h�ve at lca.st one fult-timc:emplc�}��Ae*whc�is�;ertiCac.cl �a4 a 1�<>ad }'r€�teciicary M�anagea'>�,5 def�incd in Eh$Statc�aanittt�y E;s>d�fi�r E^c�cx�5crvice F;�tabaish�nients, TOS C?�1R 590.0{.k7. €'3�:�s�at���h c-apie.5 af r,�rliticaticjn ta this�pl��:,ation. The kCeafth t�e�artmeatw[!i not use pastyea�s'reccrrd�. �'a��must providc n�sv�trpies and inaints�in s 1�te at yaur establishmebt 1. 2. _.�..._ � ;� I'"C;T2`�'C)i�J lN C'}3Aitta}:;: � I•:ach fuor!�stablishcn�nt xnust have�at lea�t on�I'er:+on in Chargc(1�''IC`�z7n sife ci'urin�ht��zr�of oper�tion. � � �l.1 t lt{�i:;N C.C.:it`17I'IC:A'1`(C):*JS:��j��; A!I itxxi:;ervrce e�tsblisltments�re z �i�ared i�:�Irave�t lea+;t ane full-tirne�mplc�ye�*ula�ha4Ailer�e-n ucrti iic�tii�rl. trs defincd in the wt�te�anitary C'erc].e f�r t�oc��ervice l:stabti:�hinc:nts,I(35('M:K S'7t).(}t}t)(ti)(>�{��). Pic:ase:aitxi;h ct��+ies c3i'cc�rtificatiic�tt to thi�aj�pliCxiian. 'T`he E[eatth Departmeni wil!ntst��e p�sty�ear:s'rec�>rds. Yntr�n��st Wruvide new+�c�p[���d m�int�e�a[ile af your esC�btishmeut, � 2. _�.. I CE:IMLICt�I C:FT27�Tl�1C.411'TC)NS: �"'`���"- � :Al1 f<>od sc:rvice e:�tablishments with 2�s�ts t�r mare nzust htive at l4asC tanc;employ'ec trained in the}ieimlich �ianeu��er nn the premisr.,�;�t.sfi tim�s. i'lea.5e list your empluye�sraineci in anti-ehokin�prou�:ciur�bcic��v�n�3 atiac;h c<�pies a#`ernptay�e c�rlalic:acions tc�this fp►�m. The Healt}�C3ep�rfinent will nat use pasf y�ars'rec�►rds. Y�u mnst provicie new eapiew�ttd maiextain�file at yaar place�f b�usiness. l. � �_.�,��........� 3, d.__ T21>S`f,�l}RA�!'T"il:A"i"[NG: Tt7Tr'�L� UFFIC:E t!SE O�iI.Y t.�llX PV(i: 1..1CS;1�IST;R�tJt7LRl7?'EE�? t'FRMTTi� LECI:I�SL•:REC�IJII2EC7 f't�� YIRM!'I'#� Llf:�hS� RFC2(31f2f�[> Et[ P1=_tt?�417',4 � 1.t3E7(il3 SiS �Fknl�t.f'R 7 t�RK SSS� �'It�TC3.. Yl ii� _ � E3&�3 E55 LAT3S[�C �_IN�3 SSS ___. . CAivfT S55 � � .�SW'tMM7NCr['tX�1.,±�116ca.. -- � > 105 ___Wf{IRL.f'K.M.?I. S21�ea F'C)ff[71Fd2Vt('ti: idt 6 Nti('REQIJlRtit) 1''I 1:; PI3RM2T'� I 4C.1zN11'it�,4�LICR1'.i7 PT?F, hk:RMll'd� I.It;f V�k'fiE L 1R,6�� I�E[• Pfilt�ft t � 1 a)1(�U SC�A'CS �l?5 _...C(7N'T1NL?J7`,hl, 535 Nt)N YRC3�t£ ��A Ithi y�A'[S S70t7 �.��. .... _. CC3h7?vTi)N VIC`. S�b4 _ WHOI,ESALh �+> _ � � _ �.RF.SIL3.Kll'C"bi�h SRt? Rk f A il.SF,Itti1C`k',: LIC f.NSE:"RP.CjL31ItI:�T) FF�f', Yk:R.hfl'I'#i i.!(',f NSE 4Lfit;�(1IRF;1) C�Eifz I�I%ItMIT#? 1,IC'f N�i.(t1:sQUIRf:t7 i"[:H i�IiKMCt ti 3ff w.t� 530 �25,0(J41 ,ft.- S2S3 F f NIJING-�t?C�L) 5a5 _�..__ —��25.�Osq.t1. �iStJ . .____,... _�`1T€Y/�*3�k�S`SEIiT �dtl � _',.�_If)AAC;CCI �lIt� _ _ w 1n�r�r.xn;vc;�;: s�s .A?4�if1t71YT U[JE�: = S •"'�'q'I.�ASE T(;RN i(IYI;N AnA CUMPi.F,'Ck:01'HF:R"a"1[)L+`QF F'OiLM••••A , AAMINiSTRATi(}N tJndcr C>ha�tcr 132,Sectic>n 25C.SubsecCion 6,thcs'["cr��n c�f Yatmc�nth is now ret7uir�cl tc�h�tld issr�a�xce�r n;newa! nf any iiccn4e nr permit tc><aper�t�a business it'a pe�c72�c�r cnm�any cicx�:;ni�t h�be Gr C;�rtitic�t�oi�Vb"c�rker's C"s�rn�nsaYic�n tn.sur.�rtc�. 7'HE AT7'ACH�:n �?ATE: W{)T�Kt�it'� �C1A'IP�1'�SATit31�i i�i+�'LII2AiVC°E AFFt1�:1VIT Ati1ST BF C+nMPLETED A1VD SIGN�.11,C)it C;Eft7'_C)F IN�tJRftl�lC:1"3 A"t"Tp1C1{[;[3 � �.._... UR WC)RKI;R'4 C`UMN,t1I�T�'i17AV1T SIC;NI3I�AN:[7 ATTACI3T3t7_.� "t"uwri caf'�arrnouth taxes azad 1ic:ns naust t�e paid pri�r i�rcn�.�•at ar issu�ce u1"yuur pc�mi�s. YI.;E;r�wE;(�'1-31:C� APIyIiC)Pf�IATFI:,Y I�'PAIL?: YC5 � N{)�_____.._...��... MO'CEL.�ANDU7'HEIZ G011UiNG�:'.a'7'ASI:.IS�CME�:N"['S TIZA9VSIFNT£X:Ct;�k'A:�CY:Fc�t pur�ase.�s afChe lirnitaiians ofMc�tcl cx Hotel u.�,Trans�ent oc;cu�ancy s}�all trc; (imized tr�the tcn��x�rary•�d shorc te,�m c�cc:upans,�y,ordinarily and custunyezity�.��cwiat�cl with ni<>tei and hatel usc;. '1`ransi�nt c�cc;u�ranEs m�st i����ve ���d be a�61a t<� �eman�tratc that thcy�naintain a�>rir�ci��l plact �7f`rc;sic�enc� cl:�ewh�r�°."T"r�nsi�t taccupancy shall g<.ncra0y reter t«contin uou.s�oceupancy c�fnot mcrrc:Chan ikai�tg{si�}days,�u�ci �ar�;a�r��;ate cs3�c�r,t inc�r�il�an ninety{9J)d�7ys withln any six(6}mrantkr pericxl. i?se c�fa�ucst unit txs a resic�t,^rac�ur u�vc;ilin�unit shssil na�be c:<znsiacrcti u-aa�sie�ii. C)ccupant-y that is:;uhj�ci ti;the cc�)lectruri oi ft.7can;C�cc.u�ait�, 1�.xcise;,as de�ned in tvT.(i.L.c.6t1G or 83t)C.`MK�tCr,.x.s amusdect,shalt g�ner�all;r t�u c<rnsid�recl"l"rans'rcnz_ � PC}KJI.S YnO i�U��Ni�iU«Al l sw imming,waifrr�g and wl�irl�ts which have tx en closec3 fc�r thc stwason musE bc:ina�es:tu# l�y�t1�c tleatth C�e;partm�ne pritsr tc�o}'yen�ng. C'ontact thc Health l"7e�acimcnt tn schedule thc inspection three{3) days prEor tu ap�ning.PL.k-,ASE N(37'k,:�'��le are Nt)'C'allowed to sit in the pc�cal area until the pool has t�ecrs ins�ectesl�tn�i apene�. �'�t�lw Wr�'1`E:.R�'ESTING: "I'h�w�a�er mu�t Fre testi_d fc�r}�s�udamanas,tt5kvl wi�fcarni and�tuncjarc�pl<stt.cc��aat by�a S�atr ce�titiw�d 1sit.x,ar�d subn�itted ia the(-Tcalth [>epartment 21�ree(3)�1�t�°s prior tt�vpt:niz��,an��irar[�:r1u c)fireafter. PftC7iL C'L4SING:Civer;;e�utdiaor in�,mu���swimmin�pc>ci!mus;t be c�rained or c:rw�re.J bvithin s�ven(7}c�says tif cJc�sin�. �'�'JtlJD SERVICF, � .'`sE:ASC)�iAf.E[)UT1 SERV!('i�(3PF:NiNG: F111 fcwd,+c:rvicc esYr�blishments must bc inspcct�i Gy th�He�tth l3epttrtment�rriur to open9ng. �'lcas€e<�ntact ch�; I lealth Gt;}�trrrtm�nt tca sch�duie thc:ins�ectinn three(3)days�riar tt�<7p�ninb. t'��"3'�}t1N�1'C1L,iCY: � � A��y�}n� 6ihp catcrs withir� th�'!'awn ai"Yarmc�uth�rautit nvti2;v Che Yaam�uth }�ealth IJep�rtment by fiii:ng the n�uircci "lc;m�x�rt�zy F�c�crd ��viee Applic•,z�iion f�rm 72 hcsars priiar ta the caiett}d cverai. `I'hcsc f'nrms can t� c��?tainu��t the I I��lih I��partmenE,or Cr€irn the'�'vwn's»�ebsite at w�w.var�riuueh.tna.us unc��r f�e�lth t7�par[mc�a�t,� t)c�wnloaclal,le t=r,�rrns. FROZE"V 17ESSER"I';; (�rcyzc:n desserts�nust t+�testc�si by a 4taz�certific�i lab rrior to�>pining ssnci�n�n#hl��thereafter,with s�un�le results su�arnxttcd t�th�:ti�:a�lth i�e:�artna��t. l�ailure tv d�sc>tivill resuti�n thc sua~�?ension ur revac�stian o!'your��r�zc,h� 17c�surt I'erm€E untxl t97e abcwe i��rrrns havc txx;n met. Ot�"14EIlFE:C'AFES: ()uts�dc,ca,°`���.e.;ouuiuo��atin�;�;tfi waitenct�siires;�scrvicc),must have pric�T�n>v��tre�m fi►e f3c�arci c�l'i ie�ith. E)Lt7't>O()R C'UUi�INC. (7titd�x}r t;<x�king,�rep�rtitic?n,c�rtlis}�tt�y t�f�any ft>ad praduct by a rekail i�r faaf service estahlishment is prAhibited. h0"t`IC:E:Pern�itsrun<utnuatly�frc�m.lanuaryltal�u:rnber3l. tTiSYUIIRFtk.'ai'{)NSI�t[.1`T'Y'I'C)Rt�_"C[.lRti 'I'E1C;C`t7tv1P1.E;`t'F;I.7Ii�.N��'Al...At'PI,IC`A`T`1C).iV(S}ANI)Kf.'>�1.7IRT:I)I�`f.l":i(�}T3Y ta�:t`T:FR�tI"3�K l�i,2f)if. ;�L1� RJ��1l�0YA`T'IG:1htS "T't7 A�iY I'CXJf� k;5`I'f�}�J.,iSE��1kiY`l', t4�Q"1`k'.t, (�R k'C3O1., ��.e., 1'AIN"T7NG. :�+I:>��` T�-QEst}'1�1EiN'f,F-.7`C.},�+1t35'1'13T;R1sPC)R'!'Gi3'I'(7 A�IC�,�I'1'Itt7VI:IJ t3�Y"T"F{i:;!3C)ARI�C�1�HE',�t,`��� Pttif:3li '1�(.)C:l>'rFtivl€NC.fsM:t:il"d1'. f2t;N�)VA']"1C)NS 14�r�Y RI2(11,lRla A Sl"1't:�,l'I.,ATtif. 1)A"1`F�'�.�r"� �'��..L S[CiNAT`[)I�I;: � d� �i� � r- ' � PRINT�t�It#ME,l��l"I't'L.�; 1� . ` � � �� i � 7�� , r� �� ,. � � ,�,. � � 1���__� t�.=,...�. � -,,� __�. � -:�°- �,. ��___� _.��._ . _ .�;� , Kev.tUii2�3ti