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Please provide all information requested; an incomplete application may delay approval <br /> FACILITY INFORM. <br /> Name of Facility: r w <br /> Street Address: i <br /> City: Zip Code: <br /> MER <br /> I <br /> BUSI <br /> Business Owner Name: 14 N R Y r.lis <br /> Home Address: <br /> Mailing Address: <br /> Telephone Number: <br /> PROPERTY O ' INFORMATION <br /> Property Owner Name: <br /> Home Address: - 0 <br /> Mailing Address: sww ) <br /> Telephone Number: _ <br /> CONTRACTOR INFORM, <br /> Name of General Contractor: <br /> Mailing Address: ; <br /> Telephone Number: <br /> Contact Person on Site: iZM4, <br /> Site Phone Number: Q 50 d <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 /> Anticipated Business Hours: Open: Close: <br /> Anticipated Number of Employees: <br /> EHD 16-01 4 PLAN CHECK GUIDE <br /> 8/01/16 <br />