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3/70 rnudcui uciNiu uHiN �,ngci <br /> NAME OF BUSINESS LIL C,OLF <br /> LOCATION 17(x$ M 'Re. u oAkLAtir) Aup-J�' <br /> street or highway city or township county <br /> LEGAL DESCRIPTION Cg Shi, W, ZD . LIO, _ - <br /> OWNER CgARI.ES AND D 14 Mailing addressM ' S AboV-E <br /> ZIP <br /> ARCHITECT OR ENGINEER /V14 Address <br /> ZIP <br /> PLUMBER i 04ar2D Noex/K3 Address 27760 /'fw 3S <br /> OC-63m , Q1. Z I P <br /> 1 . Check appropriate building usage(s) and fill in the information requested opposite <br /> each usage listed: <br /> Existing building k New building Addition <br /> If addition to existing building attach detailed memo for each. <br /> ( Drive in restaurant . . . . . . . . . Car spaces <br /> Restaurant . . . . . . . . . . . . . . . . . . Seating capacity (1 sq. ft./person) 16— )VO /��WASiytQ <br /> ( ) Dining hall . . . . . . . . . . . . . . . . . Per meal served Toilet waste Yes No _ <br /> ( ) Motel ( ) Hotel ( ) Cottages . . Number of units 2 persons/unit <br /> 4 persons/unit TOTAL NUMBER OF UNITS _ <br /> ( ) Churches . . . . . . . . . . Number of persons Kitchen Yes No <br /> Bar or cocktail llbunge . . . . . . Seating capacity (1 sq. ft./person) �— <br /> ( ) Nursing or rest h7e . . . . . . . . Number of beds <br /> ( ) Mobile home park . . . . . . . . Number of units - dependent (camper trailer) <br /> - nondependent (mobile home) <br /> ( ) Retail store . . . .L. . . . . . . . . . . . Number of employees <br /> Number of customers 10 sq. ft. /person) <br /> ( ) Service station ... . . . . . . . . . . . Number of cars served (daily) <br /> ( ) School . . . . . . . . . .I,. . . . . . . . . . . . Number of classrooms Meals served Yes <br /> No <br /> Showers provided Yes No <br /> ( ) Factory or office; building . . Number of persons ( otal alt shifts <br /> ( ) Apartments . . . . . Number of bedrooms <br /> Other . . . . . . . . . . . . . . . . . . . . . . . Specify 3 EM <br /> 2. Indicate whether or rot the following facilities areconnected: <br /> Food waste grinder ) Yes No x Dishwash r Yes No <br /> Automatic clothes asher Yes No Automatic potato peeler Yes <br /> Other . . . (Speci y) !-- No <br /> Fill in the appropriate information for the following as indicated : <br /> Septic tank capacity planned Z000 <br /> Percolation test resIts - ATTACH PERCOLATION TEST AN SOIL BORINGS/REPORT SHEET <br /> ' CSI S/21NV <br /> C= SHNXl1 <br /> COMPLETE OTHER SID <br /> ---- 0 = Aoxt x 75 <br /> G96 2013 3 ` = 72 <br />