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Please provide all information requested; an incomplete application may delay approval <br /> ENWILITY IN ON <br /> Name of Facility: <br /> Street Address: <br /> City: Zip Cod <br /> ❑ BUSINESS OWNER` <br /> Business Owner Name: <br /> Home Address: G <br /> Mailing Address: 6-v r4 VA <br /> Telephone Number: 7) Q <br /> Property Owner Name: <br /> Home Address: <br /> Mailing Address: <br /> Telephone Number: <br /> ❑ CONTRACTOR INF <br /> Name of General Contractor: <br /> Mailing Address: <br /> Telephone Number: <br /> Contact Person on Site: <br /> Site Phone Number: <br /> S <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 /> List food(s) to be served and/or provide menu: <br /> OPERATIONAL INF <br /> Anticipated Business Hours: Open: Close: <br /> Anticipated Number of Employees: <br /> can,c n, d 01 AM nucnv nI Inc <br />