2. 
3. Food Service Establishment Plan Review and Permit Application

   The intent of this application is to provide information in addition to the plans regarding the operational procedures of the facility. 

   The North Carolina Rules Governing the Sanitation of Food Service Establishments (15A NCAC 18A .2600) requires that plans be submitted to the local Health Department for approval prior to the construction, renovation or modification of a food service facility located in Craven County. The application must contain all supporting documents or it will not be accepted. All applicable fees must be paid at that time and fees may be paid over the phone or a check may accompany the submittal. 

   Please be aware that plans for franchised, chain, and prototypical facilities are also required to be submitted to the State of North Carolina Department of Health and Human Services, Division of Environmental Health, Plan Review Unit (phone number: 1-919-707-5684, website:

5. State of North Carolina Department of Health and Human Services, Division of Environmental Health, Plan Review Unit
   https://ehs.ncpublichealth.com/faf/food/planreview/index.htm
7. Submittal Checklist:

   1. Plan Review Fee (see Fees schedule on website or call 252-636-4936) 

   2. Employee Health and Personal Hygiene Plan describing process to exclude or restrict food workers who are sick, diagnosed, been exposed to food-borne illness, or have infected cuts and lesions. 

   3. A completed Food Establishment Plan Review Application (below) 

   4. A copy of the proposed menu. Indicate which food items will be produced by specialized food processes on site and indicate any food items which will be served raw, undercooked, or not otherwise processed to eliminate pathogens AND how that will be disclosed on the sample menu 

   5. A complete set of plans, drawn to scale (no smaller than 1/4”-1’), showing the location of equipment, plumbing, and lighting/electrical services. The plans and specifications should include at least the following, but not limited to: 

   • Site plan including; dumpster location, grease storage container location, entrances and exits, loading and unloading areas. 
   • A floor plan with the location of all food service equipment with each unit clearly identified 
   • Refrigeration and hot-holding equipment 
   • Utensil wash sink, dishwasher equipment with designated soiled dishes area, designated air-drying location, and designated storage of clean dishes and utensils 
   • Food preparation sinks, labeled for usage 
   • Handwashing sinks 
   • Storage rooms, garbage rooms, toilet rooms 
   • Finish schedule for each room including floors, walls and ceilings, floor and wall joint coving 
   • Electrical layout that meets lighting requirements: 50 foot-candles at food contact surfaces, food preparation area, and food cooking area; 20 foot-candles at consumer 
   • self-service, handwashing and ware washing areas; and 10 foot-candles at walk ins and dry food storage.
   • Food and dry goods storage area; Note all items shall be stored at least 6 inches above the floor 
   • Plumbing schedule, including floor drains, floor sinks, waste water lines, hot water generating equipment (manufacturer, model and recovery rate specifications shall be submitted), grease traps and/or grease interceptor location, handwashing sinks, ware washing sinks, dump sinks for bars, prep sinks and facilities for the washing of garbage cans and mops 
   • Cabinets/shelves for storing toxic chemicals 

   6. Manufacturer specification or cut sheets for each piece of equipment shown on the plans; all food service/kitchen equipment must be commercial and meet ANSI sanitation standards 

   7. Standard procedures that ensure compliance with the NC Food Code (or state which ones are being developed). Designated clearly on the plan equipment for adequate rapid cooling, including ice baths and refrigeration, and equipment for hot-holding potentially hazardous foods 

    

   Additional planning Information can be found at: 

   NC DHHS Plan Review Guidelines 

   Food Establishment Plan Review Manual 

   https://ehs.dph.ncdhhs.gov/faf/food/planreview/docs/plan-review-for-food-establishments-guide-2016-final.pdf

11. Type of Construction*

    1. New
    2. *RTAP

    1. Conversion

    1. Remodel

13. *Revisions to Approved Plans. Provide a list of all changes to the previously approved plans. Revise application as related

15. Establishment Information*

    Name of Establishment

17. Address*
19. City*
20. State
21. Zip Code
23. Phone Number*
25. Email Address*
27. Owner Information*

    Owner or Owner's Representative

29. Address*
31. City*
32. State*
33. Zip Code
35. Phone Number*
37. Email Address*

39. Title (owner, manager, architect, etc)

41.  

    I certify that the information in this application is correct, and I understand that any deviation without prior approval from this Health Regulatory Office may nullify plan approval.

43. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
45. Electronic Signature*

47. NOTE: If food service facility is served by a septic system or a well, an inspection must be conducted by the Health Department prior to submitting this application. Please contact the Onsite Water Protection section at: 252-636-4936

49. Daily Hours of Operation*
    Daily Hours of Operation Start Time

    —

    Daily Hours of Operation End Time

    Sunday

50. .*
    . Start Time

    —

    . End Time

    Monday

51. .*
    . Start Time

    —

    . End Time

    Tuesday

52. .*
    . Start Time

    —

    . End Time

    Wednesday

54. .*
    . Start Time

    —

    . End Time

    Thursday

55. .*
    . Start Time

    —

    . End Time

    Friday

56. .*
    . Start Time

    —

    . End Time

    Saturday

58. Projected number of meals served daily:*

    Breakfast

59. .*

    Lunch

60. .*

    Dinner

62. .*

    Number of food deliveries per week:

64. .*

    Number of seats:

65. .*

    Facility total square feet

67. .*
    .

    Project start date of construction

68. .*
    .

    Projected completion date

70. Type of food service: (Select all that apply)*

    1. Restaurant
    2. Food Stand
    3. Drink Stand
    4. Commissary
    5. Meat Market

    1. Sit-down meals
    2. Take-out meals
    3. Catering/ Delivery
    4. Custom Self-Service Area
    5. Other
72. Type of utensils used: *

    1. Single service (disposable)
    2. Plates
    3. Glassware
    4. Silverware
73. 1. Multi-use (reusable)
    2. Plates
    3. Glassware
    4. Silverware
75. Will specialized processes be used as specified in Section 3-502.11 of the North Carolina Food Code?*

    1. Yes

    1. No
77. If YES, indicate which processes will be used:

    1. Curing
    2. Smoking

    1. Acidification (sushi, etc.)
    2. Sprouting Beans

    1. Reduced Oxygen Packaging (eg: Vacuum)
    2. Other
79. Explain Checked processes:
81. Indicate any of the following highly susceptible populations that will be catered to or served:*

    1. Nursing Homes
    2. Assisted Living Center

    1. Health Care Facility
    2. Child Care Center

    1. School with pre-school aged children
    2. N/A
83. Will any virtual brans be provided?*

    1. Yes

    1. No
85. If YES, list brand names:
87. Menu to be served:
89. Estimated number of meals per week:
93. Cold Storage*

    How was the volume of cold storage indicate below determined to be adequate?

95. Reach-in cold storage (in cubic feet):

96. Walk-in cold storage (in cubic feet):

98. Reach-in refrigerator storage: Ft³

99. Walk-in refrigerator storage: Ft³

101. Reach-in freezer storage: Ft³

102. Walk-in Freezer Storage: Ft³

104. Number of reach-in refrigerators

105. Number of reach-in freezers

107. Cold Holding:*

     List foods that will be held cold: (Include equipment used)

109. Hot Holding:*

     List foods that will be hot: (include equipment used)

111. Cooling:

     Indicate by checking the appropriate boxes how cooked food will be cooled to 41°F (7°C) within 6 hours. 

113. Cooling Process*

     1. Meat
     2. Shallow Pans
     3. Ice Bath
     4. Rapid Chill**
     5. Category Not applicable, no cooling taking place

     1. Shallow Pans
     2. Ice Bath
     3. Rapid Chill**
     4. Poultry

     1. Shallow Pans
     2. Ice Bath
     3. Rapid Chill**
     4. Other

     1. Shallow Pans
     2. Ice Baths
     3. Rapid Chill**
     4. Seafood

     (** Check only if rapid chill equipment such as blast chillers are provided.)

115. if "Other" is checked indicate the type of food

117. Thawing

     Indicate by checking the appropriate boxes how food in each category will be thawed.

119. Thawing Process*

     1. Meat
     2. Refrigeration
     3. Running Water >70°F
     4. Cooked Frozen
     5. Microwave
     6. Category Not applicable, no thawing taking place

     1. Seafood
     2. Refrigeration
     3. Running water >70°F
     4. Cooked Frozen
     5. Microwave

     1. Poultry
     2. Refrigeration
     3. Running Water >70°F
     4. Cooked Frozen
     5. Microwave

     1. Other
     2. Refrigeration
     3. Running Water >70°F
     4. Cooked Frozen
     5. Microwave

121. If “Other” is checked indicate the type of food:

125. Food Handling Procedures: (Should be provided by owner/owner’s representative)

     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.

      

     Explain the handling procedures for the following categories of food. Describe the process from receiving to service including:

     • How the food will arrive (frozen, fresh, packaged, etc.)

     • Where the food will be stored

     • Where (specific pieces of equipment with their corresponding equipment schedule numbers) and how the food will be handled (washed, cut, marinated, breaded, cooked, hot held, etc.)

     • When (time of day and frequency/day) food will be handled

127. 1. Ready to eat foods: Edible without additional preparation necessary. E.g., salads, cold sandwiches, raw molluscan shellfish*
129. 2. Produce; grains and pasta: e.g, beans, rice, macaroni*
131. 3. Poultry:*
133. 4. Meat:*
135. 5. Seafood:*
139. Dry Storage:*

     Provide information on the frequency of deliveries and the expected gross volume that is to be delivered each time:

141. Where will dry good be stored?

143. Square feet of dry storage shelf space: ft² 

145. Finish Schedule:

     Indicate floor, wall and ceiling finishes (e.g. quarry tile, stainless steel, vinyl coated acoustic tile)

147. Kitchen Floor*
     -- Select One -- Quarry tileStainless steelVinyl Coated CementOther
148. Kitchen Base*
     -- Select One --Quarry tileStainless steelVinylOther
149. Kitchen Walls*
     -- Select One --TileStainless steelFRPDrywallOther
150. Kitchen Ceiling*
     -- Select One --Vinyl coated acoustic tileDrywallOther
152. Food Storage Floor*
     -- Select One --Quarry tileStainless SteelVinylCoated CementOther
153. Food Storage Base*
     -- Select One --Quarry TileStainless SteelVinylOther
154. Food Storage Walls*
     -- Select One --TileStainless SteelFRPDrywallOther
155. Food Storage Ceiling*
     -- Select One --Vinyl Coated acoustic tileDrywallOther
157. Dry Storage Floor*
     -- Select One --Quarry TileStainless SteelVinylCoated CementOther
158. Dry Storage Base*
     -- Select One --Quarry TileStainless SteelVinylOther
159. Dry Storage Walls*
     -- Select One --TileStainless SteelFRPDrywallOther
160. Dry Storage Ceiling*
     -- Select One --Vinyl Coated acoustic tileDrywallOther
162. Toilet Room Floor*
     -- Select One --Quarry TileStainless SteelVinylCoated CementOther
163. Toilet Room Base*
     -- Select One --Quarry TileStainless SteelVinylCoated CementOther
164. Toilet Room Walls*
     -- Select One --TileStailessFRPDrywallOther
165. Toilet Room Ceiling*
     -- Select One --Vunyl Coated Acoustic TileDrywallOther
167. Dressing Room Floor*
     -- Select One --Quarry TIleStainless SteelVinylCoated CementOtherN/A
168. Dressing Room Base*
     -- Select One --Quarry TIleStainless SteelVinylCoated CementOtherN/A
169. Dressing Room Walls*
     -- Select One --TileStainlessFRPDrywallOtherN/A
170. Dressing Room Ceiling*
     -- Select One --Vinyl Coated Acoustic TileDrywallOther
172. Indoor Garbage/Refuse Storage Floor*
     -- Select One --Quarry TileStainless SteelVinylCoated CementOtherN/A
173. Indoor Garbage/Refuse Storage Base*
     -- Select One --Quarry TIleStainless SteelVinylOtherN/A
174. Indoor Garbage/ Refuse Storage Walls*
     -- Select One --TileStainlessFRPDrywallOtherN/A
175. Indoor Garbage/Refuse Storage Ceiling*
     -- Select One --Vinyl Coated Acoustic TileDrywallOther
177. Service Sink Floor*
     -- Select One --Sink baseCoated CementVinylQuarry TileOther
178. Service Sink Base*
     -- Select One --Quarry TIleStainless SteelVinylOther
179. Service Sink Walls*
     -- Select One --TileStainlessFRPOther
180. Service Sink Ceiling*
     -- Select One --Vinyl Coated Acoustic TileDrywallOther
182. Water Supply and Sewage:
184. Water Supply*

     1. Municipal
     2. Well
185. Sewer*

     1. Municipal
     2. Septic
186. Ice*

     1. Will me made onsite
     2. Will be purchased
188. Water Heater(s):
190. Tank Type:*

     Manufacturer and model

192. Storage Capacity*

     gallons

193. Electric water heater:

     Kilowatts (kW)

194. Gas water heater:

     BTU's

196. Water heater recovery rate (gallons per minute at 80°F temperature rise)

     GPM

198. Equipment and Quantity:

     e.g.: Three-comp sink, one comp sink, two comp sink, dish machine, can wash, hand sink, pre rinse, mop sink, prep sink.

200. Equipment Drains:
202. Warewashing sink*
     -- Select One --Indirect Waste: Floor SinkIndirect Waste: Hub DrainIndirect Waste: Floor DrainDirect Waste
203. Prep Sinks*
     -- Select One --Indirect Waste: Floor SinkIndirect Waste: Hub DrainIndirect Waste: Floor DrainDirect Waste
204. Handwashing sinks*
     -- Select One --Indirect Waste: Floor SinkIndirect Waste: Hub DrainIndirect Waste: Floor DrainDirect Waste
205. WareWashing Machine*
     -- Select One --Indirect Waste: Floor SinkIndirect Waste: Hub DrainIndirect Waste: Floor DrainDirect WasteN/A
207. Ice Machine*
     -- Select One --Indirect Waste: Floor SinkIndirect Waste: Hub DrainIndirect Waste: Floor DrainDirect WasteN/A
208. Garbage Disposal*
     -- Select One --Indirect Waste: Floor SinkIndirect Waste: Hub DrainIndirect Waste: Floor DrainDirect WasteN/A
209. Dipper Well*
     -- Select One --Indirect Waste: Floor SinkIndirect Waste: Hub DrainIndirect Waste: Floor DrainDirect WasteN/A
210. Refrigeration*
     -- Select One --Indirect Waste: Floor SinkIndirect Waste: Hub DrainIndirect Waste: Floor DrainDirect Waste
212. Steam Table*
     -- Select One --Indirect Waste: Floor SinkIndirect Waste: Hub DrainIndirect Waste: Floor DrainDirect WasteN/A
213. Other
     -- Select One --Indirect Waste: Floor SinkIndirect Waste: Hub DrainIndirect Waste: Floor DrainDirect Waste
215. Warewashing Equipment
217. Manual Warewashing:*

     Size of each sink compartment (inches)                   Length                       Width                      Depth

219. What type of sanitizer will be used?*

     1. Chlorine
     2. Other

     1. Quaternary Ammonium

     1. Hot Water

     1. Iodine
221. Mechanical Warewashing:*

     1. Yes

     1. No

     Will a Warewashing machine be used?

223. Warewashing machine manufacturer and model:
225. Type of sanitization:

     1. Hot water (180°F)

     1. Chemical
229. General:*

     Describe how cooking equipment, cutting boards, slicers, counter tops, other food contact surfaces and clean in place equipment that cannot be submerged in sinks or put through a dishwasher will be cleaned and sanitized:

231. Describe location and type (drainboards, wall-mounted or overhead shelves, stationary or portable racks) of air-drying space:

233. Handwashing*

     Indicate number and location of handwashing sinks:

235. Employee Accommodations:*

     Indicate location for storing employees’ personal items (ex. coats, purses, medication, etc.):

237. Refuse and Recycalables:*

     1. Yes
     2. No

     Will refuse be stored inside?

238. 1. Dumpster
     2. Compactor

     Provisions for refuse disposal

239. 1. Yes
     2. No

     Will a contract for off-site cleaning of the dumpster/ compactor be obtained?

240. 1. Yes
     2. No

     Will the dumpster/compactor be cleaned at the establishment?

242. Describe the location for storage of recyclables (cooking grease, cardboard, glass, etc.):*
244. Service Sink:*

     Location and size of service(mop) sink/can wash

246. Insect and Rodent Control*

     1. Self-closing door
     2. Fly Fan
     3. Screen Door

     How is protection provided on all outside doors?

247. 1. Self-closing
     2. Fly Fan
     3. Screening
     4. N/A

     How is protection provided on windows (including drive-thru windows) or other openings to the outer air?

249. Linen:*

     Indicate location of clean and dirty linen storage:                      N/A (no linen storage on site)

251. Poisonous and Toxic Material:*

     Indicate location of poisonous and/or toxic materials (chemical, sanitizers, etc.) storage:

Leave This Blank:


253. 1. Receive an email copy of this form.
254. Email address

     This field is not part of the form submission.

255. Submit

* indicates a required field