Laserfiche WebLink
se provide all information requested; an incomplete application may delay approval <br /> Li ?"AGILITY INFORMATION, <br /> Narne of Facility: 2 ` <br /> StreetAddress: <br /> City: - Ll�wl ' —Zip Code: Z -I <br /> u ; ,.• JAER NAME OF FACILITY <br /> SMS <br /> Irl BUSINESS OWNER INFORMATION <br /> Business Owner Name: <br /> Home Address: _ <br /> G -- , <br /> Mailing Address: <br /> __. _ - <br /> Telephone Number: <br /> 0;PEi `f" OWNER INFORMATION <br /> Property Owner Name JL— { C I . I C NIS- <br /> Home <br /> CHome Address: <br /> Mailing Address: MJ5 _ �,('( <br /> Telephone Number: <br /> (-'PO0ITRACTOR INFORMATION � <br /> (name of General Contractor: <br /> - - <br /> I Mailing Address: <br /> Telephone Number: <br /> Contact Person on Site: <br /> Site Phone Number: <br /> ------- - - ---- ---- ------------ <br /> 0 U" LITIES <br /> Source of Facility Water Supply: C In <br /> Backflow Protection: -1�� <br /> System to be used for Liquid 1Yaste Disposal (Sewage): G� <br /> Solid Waste Disposal to be prdvided: c�Tlr <br /> Grease Interceptor: <br /> 01 F il.,D INFORMATION -- _ <br /> List food(s)to be served and/or provide menu: <br /> .q "RATIONAL INFORMATION <br /> - <br /> Anticipated Business Hours: Open: Close: <br /> ir- - - —JaAu <br /> -- —- - - <br /> Anticipated Number of Employees:_ <br /> MA , <br /> EHL 16-01 4 PLAN CHECK GUIDE <br /> 715117 <br />