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0401-059 (RC)b LICENSED CONTRACTOR DECLARATION I hereby affirm under penalty of perjury that I am licensed under provisions of Chapter 9 (commencing with Section 7000).of Division 3 of the Business and Professionals Code, and my License is in full force and effect. License # Lic. Class Exp. Date 767086 B 1 -HC A Date Signature of Contractor OWNER -BUILDER DECLARATION. 08/31/2( I hereby affirm under penalty of perjury that I am exempt from the Contractor's License Law for the following reason: ( ) I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044, Business & Professionals Code). ( ) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business & Professionals Code). ( ) I am exempt under Section , B&P.C. for this reason Date Signature of Owner WORKER'S COMPENSATION DECLARATION I hereby affirm under penalty of perjury one of the following declarations: ( ) I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. ( ) I have and will maintain workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is issued. My workers' compensation insurance carrier & policy no. are: Carrier STATE FUND Policy No. (This section need not be completed if the permit valuation is for $100.00 or less). () I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to become subject to the workers' compensation laws of California, and agree that if I should become subject to the workers' compensation provisions of Section`3700 of the Labor Code, I shall forthwith comply with those provisions. Date: ADDlicant Warning: Failure to secure Workers' Compensation coverage is unlawful and shall subject an employer to criminal penalties and civil fines up to $100,000, in addition to the cost of compensation, damages as provided for in Section 3706 of the Labor Code, interest and attorney's fees. IMPORTANT Application is hereby made to the Director of Building and Safety for a- permit subject to the conditions and restrictions set forth on his application. 1. Each person upon whose behalf this application is made & each person at whose request and for whose benefit work is performed under or pursuant to any permit issued as a result of this applicaton agrees to, & shall,'indemnify & hold harmless the City of La Quinta; its officers, agents and employees. 2. Any permit issued as a result of this application becomes null and void if 'work is not commenced within 180 days from date of issuance of such permit, or cessation of work for 180 days will subject permit to cancellation. I certify that I have read this application and state that the above information is correct. I agree to comply with all City, and State laws relating to the building construction, and hereby authorize representatives of this City to enter upon the above-mentioned property for inspection purposes. Signature (Owner/Agent) Date BUILDING PERMIT PERMIT# 0401-059 DATE VALUATION LOT TRACT $82,000.00 PAR 11 PM 29889 JOB SITE APN ADDRESS 47-150 WASHINGTON STREET, SUPT 643-090-021 OWNER "' CONTRACTOR / DESIGNER / EN (NEER DR KOURI CONSTRUCTION DESIGN SYSTEMS INC 1 REGENCY DRIVE 78401 HIGHWAY 111, 3=F-2 RANCHO MIRAGE CA 92770 LAQUINTA CA 92253 (760)771-3593 CBL49 .5830 USE OF PERMIT COM NIERCIAL REMODEL COMM- TI 3,283 SQ.FT. "LOUISE'S PANTRY" RESTAURANT A-3 OCC., TYPEV IHR, 96 OCC, 2001 CODES VALUATION 8$000,00 LS ESTEVIAnM COST OF CONSTRUCTION 82,000.00 PERI ET FEE SUNIlAARY PLAN CHECK FEE • . 101-000-439.318 $625,53 " CONSTRUCTION FEE 101-000-418-000 $558.50 - MECHANICAL FEE 101.000.421.000 $130.75 ELECTRICAL FEE 101-000-420-000 $141.85 PLUMBING FEE 101-000.419.000 $300.50 SUB -TOTAL CONSTRUCTION AND PLAN CHECK $1,757.13 LESS PRE -PAID FEFr9 $0,00 TOTAL PER -74H FEES DUE NOW $1,757,13 RECEIPT DATE BY DATE FINALED s INSPECTOR L01 c Building & Safety Department OFT1 Public Works Release to Issue Building Permit To: John Freeland, Senior Engineer Date to PWD: 1-8-2004 From: Greg Butler, Building & Safety Manager Permit #:0401-059 A. release from Public Works Department is required prior to building permit issuance forthe following project: Description: Louise's Pantry Tenant Improvement Address or general location: 47-150 Washington Street APN and/or legal description: 643-090-021 w Applicant contact and telephone number: Jorge(CDS)760-578-2631 Please do not return this form to Building & Safety Department until released for building permit issuance. For issues delaying or preventing, release, please contact applicant directly at the number above. Note: Action required (reply to Building Department or contact Applicant) within five (5) working days from date received by Public Works Department. To: Greg Butler, Building & Safety Manager From: John Freeland, Senior,Engineer The Public „Works Department has reviewed the above project and finds that: '❑ issuance of this Building Permit does not require Public Works Department approval. .:. issuance of this Building Permit is approved by,the Public Works epartment. John Fr eland, Senior Engin er Date louisespantrypwgreen — 4/18/03 P.D. BOX 1504 BUILDING & SAFETY DEPARTMENT 9 78495 CALLE TAMPICO, (760) 777-7012 OFLA QUINTA, CALIFORNIA 92253 FAX (760) 777-7011 ,To:,Greg Butler, Building & Safety Manager To CDD: 1-08-2004 From: Oscar Orci, Planning Manager Due date' 1-16-2004 Status: IST Review, Building Plans Approval (This is an approval to issue a Building Permit) The Community Development Department has reviewed the Building Plans for the following project: Description: Louise's Pantry Tenant Improvement Address or general location: 47-150 Washington Street Applicant Contact: Jorge (CDS)760-578-2631 M The Community Development Department finds that: ❑ ...these Building Plans do not require Community Development Department r approval. ...these Building Plans are'approved by the Community Development Department. ❑ ...these Building Plans require corrections. Please forward a copy of the attached corrections to the applicant. When the corrections are made please return them to the Community Development Department for review. Oscar Orci, Planning Manager L Date COUNTY OF RIVERSIDE COMMUNITY, HEALTH AGENCY DEPARTMENT OF ENVIRONMENTAL HEALTH ENVIRONMENTAL' HEALTH SERVICES ' I - SUPPLEMENTAL REPORT TO SAN. FORM # DATE o SUBJECT �--O-�I�Sf-�S llr• - �-���.; � � - � . _ _ �,—.'.,— ' � . -PERMIT NO. ADDRESS�l-�lv--(:Vr S%��� -¢G;� S� L��• i ..�_� —_._. �. INSPECTOR ... .. - REMARKS: . '' ' • �\.,� i_ �rSPP� r l�� - . S'•CL'lr(�4'Li ..—._..C..__._.=�rS. +'; ` _ !i i I� �4 i ) I ` ' c 1 u M Ufa J 1 •n r\ � r� u`� . _ .... y .. : .... ..._.._ F � " • , r! i, \ C'(.�/\fl2: �faGl �`.�CCr.� [ u.lLl- + � C'eyY..✓�1 ��Cr. •�Ir. ��`Y�,�� c.c,\Ql- t,� •, �t 5 , a , I �'i ` ' •_•_—_.��L.'-f•1���r'7n�G/U�!1"I�..U__Li Vr'\f\�r !N - • r ` �' ... .11uP_4•G'�1.w �ca,,.,0�tt p{ �1S.{�li�S•_5r,���crtt,�ei'wtil�'Y_..�..�.i•1 -4 RAL i -_' -' -- I DEHSAN-i18(RftW2) Distribution: WHITE—Office; CANARY—Owner: PINK—Office y'°r ti/Z :d C09ti'oN-' )NI Isiva}s'AS ugisaa uol1'on11suoa,' Nd6I:01'000Z '8 'aeN . COUNTY OF RIVERSIDE DEPARTMENT OF E APPLICATION TOR REVIEW OF FOOD EST NOTE: PLANS WILL NOT BE ACCEPTED UNLESS THI LI( IS COMPLETE; AND. THE PLAN CHECK FEE I PAI. ESTABLISHMENT NAME: Cit -i'1 S F kLTH AGENCY =C1 5 20 MODEL PLANS F( ' + FFICIAL USE OFFICE DATE_J FEE JOB SITE ADDRESS: CITY: t-lll`�) l �' �.�-c'„_�. ±V: CONTACT PERSON: zjoRLjE Fl V -1W Z FKAttj�XiO PHONE: -70-771--!0_15 FAX: lko -717 -' o CONTACT'S ADDRESS: l I H ( I 1 I i tT• F2 CITY: 6A 044 i" 7 -b ZIP: [ ZZJ 3 OWN ER/OPERATOR NAME PHONE: '760 -Vi( 9326 ^ A ADDRESS CONTRACTOR/ARCHITEC//T NAME ll ( "/9" Li tf urh ( PHON ADDRESS _ ( NO �TI 1 ��P CITY: A. GENERAL CONSTRUCTION:' ZIP: FAX: -7-7 3 -3697 ZIP: 11-%zlz Type of construction New Food Facility- -�✓ Remodel of Existing Food Establishment z 2! Total square footage (including all seating areas)0 Hours of Operation -74M 1taM e rD 10 Seating Capacity for dining Number of workers per shift (incl. mgmt.) B. SERVICE (Indicate ALL methods of food service to the public): MENU: A menu of food and beverages sold at this facility is required to be submitted before your plans can be checked. On-site preparation (cutting, cooking, assembly, etc.): yes &_no Soup or salad bar: yes noZ\(� Food and beverages are individually packaged by manufacturer: yes no )�C Customer Self -Service Dispensers: yes X no Full Service Bar: yes no Type of customer utensils (cups, plates, forks, etc.) Multi-seivice (re -usable)_ or Single Service (disposable) EeCTS G7�> C. UTILITIES (Will Serve Letters): NOTE: Before approved plans are released, the applicant shall provide to this Department Will Serve Letters which state the establishment is or will be connected to the utility. ,, Water Service: Public Water System NAME OF WATER COMPANY: (f,V IAI Q Private Well (Must be potable) Sewage Disposal: Public Sewer System NAME OF SEWER COMPANY: w D Septic System (must be Environmental Health Land Use approved). Grease Interceptor: Provide from Sewer District a Grease Interceptor size requirement letter or waiver letter. OWNER/REPRESENTATIVE DECLARATION: I certify that I have read the entire application and state that all information is correct. I under- Itand that the amount of fee paid is based on my declaration of information on this form, and that incorrect information is grounds for denial of the submitted plans. I also unde at plans wr rded if not picked up within sixty (60) days of approval or denial, and that no inspection ofmyestablishment w: a onducted, or approval granted operate, until all proper information requested has been received and plans have been approved and return I h e reviewed the Plan Construction uide and my plans follow the guide. Signature _ DEH -SAN -002 (Rev Date --7, . Distribution: WHITE—Office; YELLOW—Customer COUNTY OF RIVERSIDE COMMUNITY HEALTH AGrO ;01ST. # iy DEPARTMENT OF ENVIRONMENTAL HEALTPLAN CORRECTION 2 5 2003 Plan Check # NO3-055 .3. DBA Louises Pantry/BBQ Address' -47-150 Washington St., La. Quinta Plans Submitted by Jorge Rivero/Francisco Aguilar Phone (760)'771-3593 Owner William Emmett Address 44-491 Towne Center,A, Palm Desert Phone (760)333-219.4 The plans are now approved subject to the conditions listed below and the attached compliance sheet. 1. This facility will be approved with two operational kitchens; however. as constructs it may not be separated into two independent facilities because of shared fixtures_ -At the time of the final inspection a single environmental health permit will be issued for the entire site. Both kitchens must be under the'same management and will share one grade card. If this arrangement is unacceptable to you please contact this office for instructions on the modifications needed to separate the plans. 2. The smoker must be installed according to the manufactures instructions under a fire proof canopy. A copy of these instructions must be made available prior to com- pletion of the final inspection. Additionally the air. velocity must meet the manufacturers specifications. 3. An air balance report will be required prior to completion of the final inspection. CONSTRUCTION INSPECTIONS: Contact the Plan Checker for a Preliminary Inspection when construction is approximately 80% complete, with plumbing, rough ventilation, and rough equipment installed. Request for inspection should be made at least five (5) working days in advance. A FINAL INSPECTION MUST be made upon completion. of ALL work including finished details. APPROVAL to operate shall not be granted, or,r6modeled areas approved to operate, until the facility has passed the FINAL INSPECTION, and "APPLICATION TO OPERATE" has been completed and PERMIT FEES have been paid. Request for- inspection should be made at least five (5) working days in advance. PLANS CHECKED BY David E. Day Phone (760)320-1048 I acknowledge the corrections noted herein and as indicated on the plans and agree to incorporate them during construction: Signature Company Date DOH -SAN -178 (Rev 01102) Distribution: WHITE—Office; YELLOW—Applicant; PINK—Bldg. Dept. r. it COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY DEPARTMENT OF ENVIRONMENTAL HEALTH ENVIRONMENTAL HEALTH SERVICES SUPPLEMENTAL REPORT TO SAN. FORM # 178 DATE 8.20.3 (Page 2 of 2 SUBJECT Louises Pantry/BBQ PERMIT NO. Const. ADDRESS 47-150 Washington St., La Quinta INSPECTOR David E. Day REMARKS: 4. Install a hand sink in the pantry cooking area located within the same room as the cookline. The single sink located in the prep area is not readily accessible for the cooks and will not facilitate proper hand washing. 5. All floor wall and,ceiling finishes in food service areas must be smooth and easily cleanable to include waitress and self service stations such as drink dispen- sers. Water proof finishes to a height of 8' must be installed behind all wet areas such as 3 compartment sinks, mop sinks and food preparation sinks. aSS) 6. The trash enclosure must be finished so that the interior floor and walls are smooth and easily cleanable. Seal these surfaces with a 2 part epoxy. 7. All exterior and restroom doors must be self closing. E:;terior doors must also be sealed against entry by vermin. 7. Approval of this plan does not include approval by local land use, water or sewer agencies. Prior to commencing construction or undertaking improvements, submit these plans.to the Riverside county. 'Land Use Agency located at 82675 Hwy 111, Room 201 Indio CA 92201. Phone .(760.863-7000. A facility may not receive an ..1 .U4 U a l l 1, e-4 �F4. 1 nri nr to til? r.1LV.LL I,LLUMIL L.G1 MCL L. LL LCL WLL I. wia.-- —'— .+YY �. , — , ••------ ••--- --------- a - - - Final Inspection. 8. A compliance guide is attached to this plan.correction sheet. All construction no otherwise addressed on this plan correction must be performed in.accordance with the idelines set forth therein. DEH•SAN•118 (Rev 2/96) Distribution: WHITE—Office: CANARY—Owner: PINK—Office j , io air i ne 1-000 PREPARATION AREA(S). A MINIMUM OF 100 SQUARE FEET OF FLOOR IS REQUIRED FOR DRY STORAGE OR AT LEAST 32 LINEAR FEET (32 FEET MEASURED LINEARLY ON THE FLOOR) OF APPROVED SHELVING WITH A MINIMUM OF 18" IN DEPTH AND AT LEAST THREE TIERS HIGH. WHEN A BAR IS LOCATED WITHIN THE ESTABLISHMENT, THE BACK UP STORAGE OF 16 LINEAR FEET REQUIREMENT FOR THE BAR MUST BE PROVIDED IN ADDITION TO THE REQUIRED BACKUP DRY STORAGE. 4TROL FANS .- ALL DOORS LEADING TO THE EXTERIOR OF THE FACILITY FROM A FOOD SERVICE AREA SHALL BE FITTED WITH AN APPROPRIATE INSECT CONTROL FAN LOCATED DIRECTLY ABOVE THE DOOR WITH A VELOCITY OF NOT LESS THAN 1600 FEET PER MINUTE MEASURED AT 3 FEET ABOVE THE GROUND. )DORS . - EXTERIOR DOORS SHALL OPEN OUTWARD AND BE SELF CLOSING. API INTERCEPTOR . - A GREASER INTERCEPTOR IS PLANNED TO BE INSTALLED FOR THIS FACILITY. SEE PLUMBING CONTRACTOR'S PLAN FOR GREASE INTERCEPTOR SIZE AND FINAL LOCATION. THE TRASH AREA FOR THE ESTABLISHMENT IS LOCATED AT THE OUT SIDE OF THE BUILDING PROPER. A CONCRETE SLAB SHALL BE PROVIDED FOR TRASH BIN. ALL WALLS SURROUNDING THE AREA SHALL BE SMOOTH, SEALED AND WASHABLE. SEE SITE PLAN FOR LOCATION. .TH. DEPARTMENT APPROVAL NOTES se plans by the County of Riverside nwron:;t�n '. ': " °'i�, does not relieve the :hiteot of ih.(::i for the Engineering design." PLUMBING, MECHANICAL, AND STRUCTURAL . 'TALLATIONS SHALL BE DONE UNDER PERMIT 'G.AND SAFETY LARY AND FINAL. INSPECTIONS ITMENT OF ENVIRONMENTAL �F-za 3VAL ODES NOT INCLUDE THE TIC SYSTI :�:Ql, G = F/%SE INTEPCEPTOR ISTE DISPOSAL SYSTEM. OBTAIN FROM APPROPR,1ATE AGENCY WASTE DISPOSAL SYSTEM. P�lrmanOnt aPProved dispensers must sOaP and- towel installed tt 11! hand washing sine ft and cold running water through a mixing faucet shall be provided at all sinks.:., --- SHEET INDEX .ET K 1.0 FOODSERVICE NOTES SET K 1.1 FLOOR PLAN =ET K 2.0 FOODSERVICE EQUIPMENT PLAN .ET K 2.1 FOODSERVICE EQUIPMENT PLAN (LOFT AREA) AKL INTENDED TO 5UIT EQUIE BE 5UPPUED . WE WILL NOT E RE5PON51BILITY FOR ANY Wt BY SAID CONTRACTOR5 AND STAND ANY EXPEN5E.FOR CH MADE NECE55ARY BY LOCAL CODE5 . ORDI NANCE5 .5TRU CONDITIONS OR BY 5UB5TITi CHANGE5 IN EQUIPMENT 5HC THE5E PLAN5. THESE PLANS MUST BE VERIF APPROVED BEFORE DETAILIN STARTED. THESES PLAN5 , DI AND SPECIFICATIONS ARE PR FAD AND CAN NOT BE REPRO CHANGED OR COPIED IN ANY WHAT50EVER WITHOUT THE E WRITTEN CONSENT OF PAD. 1- F-XPRE55LY RE5ERVE5 ITS CC LAW COPYRIGHT AND OTHER 1 RIGHT51N THE5E PLAN5 , 5UC DUPLICATION WILL BE A DIREC TION TO THIS AGREEMENT AN TO LEGAL ACTION . REVI: SHEET T FO®DSERVI AND H EAL7 DEPARTMEI NOOTES Scale: PROJECT TI LOUISE'S PANTRY = QW 47-150 WASHINGTON S1 LA QUINTA , CA. 92253 DATE : ISS` Feb 12, 2004 7;5IAM :Const:ruction',Design Systems, IN( No 0686 P - 3 SECTION D: INTERCEPTOR/WITH.SAMPLE BOX I. TYPE OF INTERCEPTOR: GREASE )r LINTr^" �-[-]..OIL � ]SAND ] ' OTHER ' MODEL N0. OF COMPARTMENTS CAPACITY Q 'OTHER METHODS OF PRETREATMENT ATTACH DRAWING SHOWING PROPOSED LOCATION OF INTERCEPTOR INCLUDING CONNECTION•To ! DISTRICT SEWER. PROVIDE RIVERSIDE COUNTY ENVIRONMENTAL HEALTH DEPARTMENT PERMIT. 's 2. EXISTING FACILITIES: `! DATE OF INSTALLATION LOCATION: (if not shown on•plumbing plans) 3. PROPOSED FACILITIES FOR ALL NEW INSTALLATIONS, APPLICANT IS REQUIRED TO NOTIFY DISTRICT 48 HOURS IN ADVANCE FOR INSPECTION. ESTIMATED DATE OF INSTALLATION SECTION E: CERTI TION Z HEREBY CERT T THE INFORMATION FOUND IN S APPLICATION IS FAMILIAR TO ME, IS COMPLETE, AN REP TF,,STATEMEN FACT TO"'n]E BEST OF MY KNOWLEDGE. SIGNATURE :.TI.LE PRINT NAME DAi'E DISTRICT USE ONLY_ . ACCOUNT NO. ,. ' RIVERSIDE COUNTY ENVIRONMENTAL -HEALTH DEPT. PERMIT RECEIVEI. DATE BY WSBFC RECEIVED AMOUNT DATE 'MCR./INV. N0. BY BY SCC RECEIVED AMOUNT DATE MCR./INV: NO. By , EAU CALCULATION DATE By PLUMBING PLANS INCLUDING ISOMETRIC, DRAWINGS RECEIVED DATE By DRAWING SHOWING LOCATION OF INTERCEPTOR RECEIVED .)ATE PLAN REVIEW DATE By INSTALLATION INSPECTED ;)ATE BY BY SEPARATE LATERAL INSPECTED (OBSERVED) DATE' BY i MONTHLY INTERCEPTOR SURCHARGE DUE: YES NO DATE BY COMMENTS DATE BY ;, ,. CVWD-090 I (Rev. 7/96) SEE NOTE NO. 2 - N SEE NOTE NO. 3 � vent. .2'way cleanout o o A_ WRET J EM . CT outlet PLAN VIEW I ►nOc sanitary tee running trap BOL7 DOlwi ti iRA4E W AND AN0 G5f IIEOM D COVEIt o — . •� .. ,� - - • TO AIAOE Oi .. �� `a•'y:.r: .•�.�c:-ts. �r:,�. y. � i MOT�Tr7AS �vD .. IN LET°r - — OUTLET _ - 3 1/4" TYPICAL + s SbE_. - TTEilY GPBiIlIO SEE sPEa BEET NO. 5-mV. U4ilD CEY1H . ' m : ; i ro SEC710M A–A EXCAVATION SPECIFICATIONS ALL DlRENSIONS W INCHES C-3750 C -4S00 LEN07H MODEL I A B C. 4 E F G H PC 0'31100 50 48 ' 65 74 - 74 243/4 4 1/2 41 1/2 PC G-3750: 59 57 74 74 74 29 3/4 4 1/2 50 1/2 PC G-4500 ! 62 1/2 60 1/2 77 1/2 e585 30 3/4 5 53 1/2 EXCAVATION SPECIFICATIONS MODEL 0-3000 C-3750 C -4S00 LEN07H 31'-0" 31'-0" 311-4" VADTH f0'-0" 10-0" 11'-0" BELAY INLET 4'-2" 4'-11" 5'-2 1/2' TANK HEIGHT 5'-5" Li `S 3/4- rIPWAL am a—J TMU SHOE W= SLUMS OUTLET END l9EfY 0 0 Feb 12 2004 1 51AM Cons tructionsDEsiban Systems, 1N( No 0686 P. 2 INTERCEPTOR APPLICATION` /PERMIT WITH ! COACHELLA VALLEY WATER DISTRICT,�'POST OFFICE BOX 1058 COACHELLA,, CALIFORNIA 9223'6 Phone(619) 398-2651 INTERCEPTOR APPLICATION 4 SECTION A: GENERAL INFORMATION ' BUSINESS OWNER'NAME:RN4 L BUSINESS OWNER ADDRESS: rs+vC� ✓t, PHONE: PROPERTY OWNER NAME: -�54►.ors ,A PROPERTY OWNER ADDRESS: fc H. le PHONE: BUSINESS NAME: z.5 ADDRESS: WN5D Wltc-+t A — �.` (^A I3 PHONE: PERSON TO CONTACT FOR SERVICING, PHONE: SECTION B: SERVICE INFORMATION` f CHECK ONE: EXISTING DISCHARGE [ ] PROPOSED DISCHARGE [)Q 'aF PROPOSED DISCHARGE, ANTICIPATED DATE OF DISCHARGE_ 1. CHECK ALL ACTIVITIES WHICH ARE PRESENT AT YOUR FACILITY: [K] OFFICE . [ ] MANUFACTURING j ]'PRINTING/PHOTO FINISHING RETAIL/WHOLESALE' [ J ELECTROPLATING [ ] CHEMICAL BULK STORAGE L ] WAREHOUSE {' J, FLAMMABLES [ ] [ ] ASSEMBLY. [ ].CAR WASH ( ] OTHER [ ] LAUNDRY [>9 FOOD PROCESSING [ ] OTHER ]HOSPITAL( ];REPAIR SHOP/GARAGE [ ]OTHER 2. IF RESTAURANT NO. OF SEATS 37TF LAUNDROMAT N0. OF WASHERS 4. .`IF GAS STATION NO. OF PUMPS WATER SOURCE: j CVWD [ ] Other IS WATER SUPPLIED BY LANDLORD?[ J YES Nb WHICH BUSINESS NAME APPEARS ON WATER BILL ' NOTE: EACH INTERCEPTOR REQUIRES ITS OWN SEWER LATERAL. SSpARATE FROM THE REST OF THE BUILDING'S PLUMBING,CONNECTED DIRECTLY TOTHB llISTBICT-S SEWER SYSTEM. SZGTIOti'.C: ..WASTE GENERATION I. LIST DISCHARGE FLOWS, IF KNOWNs TYPE OR . CONNECTION NO. SEWER SIZE'; AVG. FLOW STRENGTH 2 2. ATTACH COPY OF THE PLUMBING PLAN INCLUDING ISOMETRId,DRJ.WINGS. CVWD_090 (Rev. 7196)