Laserfiche WebLink
Please provide all information requested; an incomplete application may delay approval <br /> ❑ FACILITY'INFORMATION - a, <br /> t <br /> Name of Facility: (on on <br /> Street Address: MWAVAywr :X. <br /> City: V a(, Zip Code: <br /> ❑ FORMtR{N E OF,FACILITY <br /> ❑ BUSINESS OWER 1NFORMATIO_N:es;<_ <br /> Business Owner Name: evr — )aA-k-n PrSU <br /> Home Address: O p 01 <br /> Mailing Address: 1\ " <br /> Telephone Number: <br /> JIPROP <br /> Property Owner Name: (ICICS on r- Cal_ <br /> Home Address: 5 m <br /> Mailing Address: %I 1, <br /> Telephone Number: <br /> 13100 TRACTOR I <br /> Name of General Contractor: S rU(11 <br /> Mailing Address: qswvp <br /> Telephone Number: _ <br /> Contact Person on Site: <br /> Site Phone Number: 0 - $ (� <br /> ❑-U,TILITIES <br /> Source of Facility Water Supply: <br /> Backflow Protection: <br /> System to be used for Liquid Waste Disposal (Sewage): <br /> Solid Waste Disposal to be provided: <br /> Grease Interceptor: <br /> ❑ FOOD INFORMATION <br /> List food(s)to be served and/or provide menu: <br /> OPERA; O <br /> Anticipated Business Hours: - Open: Close: <br /> Anticipated Number of Employees: <br /> EHD 16-01 4 PLAN CHECK GUIDE <br /> 7/5/17 <br />