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HomeMy WebLinkAbout2055 CORTE DEL NOGAL; ; 87-104; PermitDECLARATIONSLENDERI' 5 tin• S s 3 -WORKER'S COMPENSATION OWNER/BUILDER CONTRACTORs||.H, o 3i 3 3Sfso ;ig co o o w Q-J« S =^s P BE*0 t s S i*f -1 I > z oilPiHII|-^f i111; Isof^^^,? C3c\"a53alii I = i3stv if ??^&8|lBlII a!s^ I Q2S3S-^I aSS^lsigiI5;_ ia3co«Q.* White — Inspector Green — (1) Finance Yellow — Assessor Pink — Applicant Gold — Tefwporary File *^-~-s SPECIAL CONDITIONS. |s-U\^_ ^v•^s^»s^^HScXf*§I^\(BUILDING *KM«.«•)^^Vi\J '"", 0COJ£'**lt /* V:V %^ fV*i;vV ;' 1f__^._ •- ;; < 1 j N y 2mCI>zr>r ..ELECTRICAL '/PLUMBING ••n^r-(CALL FOR FINAL IN SPEC]ITEMS AROVF HA''*** -^Jrnos2rf| ^-n<2:3:W ^Br~0^S^55OTJ3)0"^Zhi.-Hm C o-a i c.A* •X. c ^•• f 11 *• "* 4 •^ o J o VENTILATING SYSTEMS ji;^-_^'.,V' ™ __..•HEAT - AIR COND SYSTEMS 1i•;"*--i • , - ", • nDC0TJ|—[?2~n31m^nzQ.;r' ;t *! 11nzzor- ! ""..•* ,'*\D BONDING D POOL j,.D ELECTRIC SERVICE D TEMPIO313) '/f^" \ 'J 1 ; /*}ROUGH ELECTRIC 1V. f) nmmC30Czom31O3JOCZOjnTLjCFT31 , f 1 > f ' I /ELECTRICAL i< - ''--I ;.' r .-* i i * , «,» ;D WATER HEATER D SOLAR VlHm33 k- |1j i 0COHmCO.—•nn D r TUB AND SHOWER PAN J. } •-•_ oocn§mn^Hm31^Tlnr>>s></)•Q Zn ^ / ; 1 UNDERGROUND D WASTE D1m31aC{f ^ nCOmm31zoCDI—Ooar;O0X~iinum ^CT T PLUMBING iTlmb5m O Z J' "' i- • noziirn m n3CDr:sc:««3rrTcHH Z 52 Tl 'nD5D>HC03t>>C INSULATION i*> -o*» TJ3 r->J m 0 j ,EXTERIOR LATH,*••c ••*>< ^b c0 ^S| 'p-T O, zo TJn rn i '.. , f i 'FRAME,czc r Z ' Z 0" C3r:2CCncnC0•;n:-3C3—cr)Cn>HCp5]j)i]0I-1>3J C3 C) FH C) C L: r r COCCDTl3)maTlOO33n0mrzo03->•N • 5 > 75n '. *' ^GUNITE OR GROUT^^,rn C5--H O 'z Q m m 00 m ^ D >Z TJ ^ ~0 ^ 33 OO _)>o co D Hm ,-* " '. ' *• Tf , ^ . ', S>131 1 - r CC 5r C 0Tn C Jr C/1nC C2<J Z COTlmC —03 00 Z 0 ^min t 3nznC3CnC0nnr Dn D Dn 3 T 315> i 3T) H j j J1>1)3)1J31]FOUNDATIONTlmi —oz CO TJmO oz H3mp.1 1O DO O *,BUILDING., / ' * ': - TJmimzCO•om^JO » " $""""••— t • \ J j FINAL BUILDING INSPECTION PLAN CHECK NUMBER PROJECT NAME ADDRESS PROJECT NO TYPE OF UNIT CONTACT PERSON. CONTACT TELEPHONE. DATE 3-15-89 2055 Corte Del Noael UNIT NUMBER Comm Tl NUMBER OF UNITS PHASE NO Mike Hatton 480-1625 blda. ena. plan, fire, water INSPECTED BY INSPECTED BY INSPECTED BY INSPECTED DATE INSPECTED DATE INSPECTED MAR 1 fe 1989 APPROVED APPROVED APPROVED DISAPPROVED DISAPPROVED DISAPPROVED Costa Real Municipal Water uisinci COMMENTS Engineering Department (619) 438-3367 1 f^\ f ^ (§ fi1 p \y7R »N ^i\\J! "'"' 'I i . _ lii * ir \ ji •• ^ I /^ ^^^-^ hl ! 1 MMK 1 b t9o3 |j | ' M !: " ./ COSTA RTAlT™™' UiMi'C'PAL WATER DI-JTfJCT Rev 1/86 WHITE Suspense BLUE Water District GREEN Engineering CANARY Utilities PINK Planning GOLD Fire FINAL BUILDING INSPECTION PLAN CHECK NUMBER PROJECT NAME ADDRESS PROJECT NO TYPE OF UNIT CONTACT PERSON. CONTACT TELEPHONE. DATE 3-15-89 2055 Corte Del Nouel UNIT NUMBER Comm Tl NUMBER OF UNITS PHASE NO f.tike Hatton 480-1625 bldd. ena. plan, fire, water INSPECTED BY INSPECTED BY INSPECTED BY DATE INSPECTED DATE INSPECTED DATE INSPECTED APPROVED APPROVED APPROVED DISAPPROVED DISAPPROVED DISAPPROVED COMMENTS '#" ', t Rev 1/86 WHITE Suspense BLUE Water District GREEN Engineering CANARY Utilities PINK Planning GOLD Fire FINAL BUILDING INSPECTION PLAN CHECK NUMBER PROJECT NAME ADDRESS PROJECT NO TYPE OF UNIT CONTACT PERSON. DATE 3-15-89 2055 Corte Pet Noqel . UNIT NUMBER Cumm TJ NUMBER OF UNITS .PHASE NO Mike Hatton CONTACT TELEPHONE 180-1625 btdq. <anci. plan, fire, water INSPECTED BY INSPECTED BY INSPECTED BY DATE INSPECTED*. DATE INSPECTED DATE INSPECTED APPROVED APPROVED APPROVED DISAPPROVED DISAPPROVED DISAPPROVED COMMENTS Rev 1/86 WHITE Suspense BLUE Water District GREEN Engineering CANARY Utilities PINK Planning GOLD Fire ESGIL CORPORATION 9320 CHESAPEAKE DR., SUITE 2O8 SAN DIEGO, CA 92123 (619)560-1468 DATE: JURISDICTION: O PVfZjL^BfiS (JPTAN (JHEUKETtQFILE COPY PLAN CHECK NO: H *~( ~ I ^^T " -L QUPS nDESIGNERx*""7x^ / *...•* f **»* j L i ^~-.*-^ li I XT* j^« . x\ . i—*PROJECT ADDRESS: <lO~-?O C.Or<lTfc±L PROJECT NAME: TTl , ' Ll D The plans transmitted herewith have been corrected where necessary and substantially comply with the jurisdiction's building codes. The plans transmitted herewith will substantially comply with the jurisdiction's building codes when minor deficien- cies identified are resolved and checked by building department staff. D The plans transmitted herewith have significant deficiencies identified on the enclosed check list and should be corrected and resubmitted for a complete recheck. fisa The check list transmitted herewith is for your information. i® The plans are being held at Esgil Corp. until corrected plans are submitted for recheck. The applicant's copy of the check list is enclosed for the jurisdiction to return to the applicant contact person. The applicant's copy of the check list has been sent to: ;/ Esgil staff did not advise the applicant contact person that plan check has been completed^ OTHeys. TH-va- si I I Esgil staff did advise applicant that the plan check has been completed. Person contacted: Date contacted: Telephone #_ REMARKS: ESGIL CORPORATION HO. JURISDICTIOH: J Q4--TT 10: flufr Cft. PROJECT DATA OCCUPANCY: BUXLDING USE: JOTS OF CONSTRUCTION:. ACXOAL AREA: (2 /IXOHABLE AREA:_ STORIES: HEIGHT: SPRINKLERS: OCCUPANT IJOAD: REMARKS: PLAN CORRECTION SHEET TENANT IMPROVEMENT Date plans received by lurisdiction; KlLfD Date plans received by Esgil Corp.; Date initial plan check completed: Applicant contact person: 4-fto 1 fa z ^r FOREWORD: PLEASE READ Plan check is limited to technical requirements contained in the Uniform Building Code, Uniform Plumbing Code, Uniform Mechanical Code, National Electrical Code and state laws regulating energy conservation, noise attenuation and access for the handicapped. The plan check is based on regulations enforced by the Building Inspection Department. You nay have other corrections based on laws and ordinances enforced by the Planning Department, Engineering Department or other departments. Present California law mandates that construction comply with Title 2t and the applicable model code editions adopted, with or without changes, by the various state agencies authorized to propose building regulations for enforcement at the local level. Code sections cited are based on the 1982 UBC. The above regulations apply to construction, regardless of the code editions adopted by ordinance at the local level. The circled itens listed need clarification, modification or change. All items have to be satisfied before the plans will be in conformance with the cited codes and regulations. Per Sec. 303 (c), 1982 Uniform Building Code, the approval of the plans does not permit the violation of any state, county or city law. To soeed up the recheck process, note on this list for a copy) where each correction item has been addressed, i.e . plan sheet, specification. etc. Be sure to enclose the marked up list when you submit the revised plans. NOTE: PACE NUMBERS ARE HOT IN SEQUENCE AS PACES HAVING HO HEMS NEEDING CORRECTION WERE DELETED. List No. 50, TENANT IMPROVEMENT WITHOUT SPECIFIC ENERGY ZONE DATA OR POLICY SUPPLEMENTS 2/10/87 Pleise make all corrections on the original tracing* and submit two new sets of prints, and any original plan sets that may have been returned to you by the jurisdictions, to Esgil Corporation, 9120 Chesapeake Drive, Sui-te 203, "Ian Diego, CA 92123, (619)560-14S8. Please make nil corrections on the original tracings and submit two new sets of prints, and any original plan sets that may have been returned to you by the jurisdiction, to- The jurisdiction's building department. The responsible designer is required, to sign each sheet of the plans. A —\ State-licensed Architect or Engineer ) is required where there are structural ^~\ changes to an existing building or •<. a structural addition. (Business and _^ Professions Code). Provide the correct address and suite number of tenant space on the plans. Section 302. Provide a note on the plan indicating the previous use of the tenant space or building being remodeled. Section 302. When the character of the occupancy or use changes within a building, the building must be made to comply with current Building Code requirements for the new occupancy, please provide complete details to show the building will comply. Section 502. t)BC Section 304 requires the Building Official to determine the total value of all construction work proposed under this permit. The value shall include all finish work, painting, roofing, electrical, plumbing/ heating, air conditioning, elevator, fire exting- uishing systems and any other perma- nent equipment. Please provide a signed copy of the designer's or contractor's construction cost estimate of all worX proposed. Provide a plot plan showing the distances from the building to the property lines and the location of tenant space (or remodel) within the building. On the first sheet of the plans indicatej Type of construction of the existing building, present and proposed occupancy classifications of the remodel area and the occupant load of the remodel areas and total building area. Specify on the plan title sheet the Building Code Edition used for the design of the proposed work Provide a fully dimensioned floor plan showing the size and use of all rooms or areas within the space being improved or altered Draw the plan to scale and indicate the scale on the plan. Indicate the use of all spaces adjacent to the area being remodeled or improved. Show any existing fire rated area sep- aration walls, occupancy separation —? walls, shafts or ratedcor^ridors.^^ ; Identify and provide c&rrS^ructTon^de- tails for proposed new fire rated walls. Specify on the plans the fire ratings of assemblies to protect proposed open- ings in existing or new fire walls. Identify existing walls to be removed, existing walls to remain and proposed new walls. Identify bearing walls, non-bearing walls, and shear walls. Provide a section view of all new interior partitions. Show: (a) Type, size and spacing of studs. Indicate gauge for metal studs. Specify manufacturer and approval number or indicate "to be ICSO approved". (b) Method of attaching top and bottom plates to structure. (NOTE: Top or partition must be secured to roof or floor framing, unless suspended ceiling has been designed for partition lateral load). (c) Wall sheathing material and details of attachment. (Size and spacing of fasteners). (d) Height of partition and suspended ceiling. Provide notes and/or details to show that the floor and wall finish in toilet rooms are surfaced with a smooth hard non-absor- bent material extending five inches up the wall. Similar surfacing shall be pro- vided on the walls from the floor to a height of 4 feet around urinals and within water closet compartments. (3s) "no C ~ TVK?" \S'/ 5 / Note on the plans "All interior finishes must comply with Chapter 42 of the UDC". Specify "class flama spread rating (minimum) for __ Lateral bracing for suspended celling must be provided. (UDC Table 23-J) Where ceiling loads are less than 5 PSF and not supporting interior part- itions, ceiling bracing shall be pro- vided by four No. 12 gauge wires secured to the main runner within 2 inches of the cross runner intersection and splayed 90" from each other at an angle not exceeding 45* from the plane of the ceiling. These horizontal restraint points shall be placed 12 feet o.c. in both directions with the first point within 4 feet of each wall. Attachment of restraint wires to the structure above shall be adequate for the load inposed. Draft stop any suspended ceiling in wood frame floor construction every 1,000 sq. ft. and in attics of com- bustible construction every 3,000 sq. ft. The maximum distance allowed between draft stops is £0 feet. Section 2516(f). The tenant space and new and/or existing facilities serving the remodeled area must be accessible to and functional for the physically handicapped. See the attached correction sheet. Title 24, Part 2. Show the exit sign locations; show any required directional exit signs. Section 3314. Rooms with more than 10 occupants may have one exit through one adjoining room,. Revise exits to comply. Section 3303ie) Two complying exits are required from Klfl. \nfZ- Exits must be, and main- ' tain, a distance apart of at least 1/2 the maximum diagonal dimension of the area served by the exits. Section 3303 Asse-nbly rooms with more than 50 occupants shall not have a lock or latch on exit doors unless they are equipped with panic hardware. Section 3318. Note on the plans* "All exits are to be opcnable from inside without the use of a key or special knowledge". In lieu of the above, in a Croup B occupancy, you may note "Provide a sign on or near the exit doors reading THIS DOOR TO REMAIN UN- LOCKED DURING BUSINESS HOURS'. Required exit doorways shall be not less than 16 inches in width and not less than 6 feet - 8 inches in height. Section 3304(e>. Exit doors shall swing in the direction of exit travel (occupant load exceeds 50). Section 3?04(b). Show the locations of existing exits from the building and show the path of travel from the remodel area to the existing exits. Corridors must provide continuous pro- tection to the exterior of the building. Interruptions by intervening room is not permitted. Foyers, lobbies or reception rooms constructed as required for corridors are not considered inter- vening rooms. Show exit corridors as 44 inches wide minimum. Deadend corridors are limited to 20 feet when more than one exit is required from the corridor. Section 3305. Provide one-hour construction details for all corridor walls and ceilings serving an occupant load of 30 or more. Identify all rated corridors. Walls of reception rooms and lobbies which are included within protected corridors must have walls and ceilings constructed as required for corridors. Protect all interior openings in corridor walls and ceilings. Door and frame must be labeled 20-minute smoke and draft control assembly with self-closers or automatic closers with smoke detectors. Section 3305(h). Glazing must be 1/4 inch-thick wired glass installed in steel frames and cannot exceed 25 percent of the common wall area. Section 3305(h)2. »| Show the location of fire dampers, provide fire dampers at duct pene- trations of fire-rated occupancy and area separations, shafts and corridor walls and ceilings. Section 4J06IJ). SECOND GENERATION NONKESIDENTIAL PNERCY STANDARDS EFFECTIVE FOR PERMIT APPLICATIONS SUBMITTED AFTER 12/31/86 Provide mechanical ventilation in all rooms capable of supplying a minimum of 5 cubic feet per minute of outside, air with a total circulation of not less than 15 cubic feet per minute per occupant. Section 605 and 705 Imprint on the plans the Certificate of Compliance (CF-1) previously pre- pared for the entire building, or for prior tenant improvements in the build- ing, all conditioned A,B,E or H, new or existing. If no Certificate of Compliance (CF-1) was previously prepared then one should be prepared and imprinted on the plans; all conditioned A,B,E or H, new or existing. If the existing building was a shell or speculative building without the HVAC system installed, and conditioned office space is being proposed, provide the Certificate of Compliance (CF-1) imprinted on the plans and provide backup documentation to show complete compliance with the Second Genera- tion Nonresidential Energy Standards. If the HVAC system and energy design were installed at the time of initial building construction, provide a copy of the Energy Compliance documentation and also imprint a completed Certificate of Compliance (CF-1) on the plans; all A,B,E or H, new or existing. If lighting is being initially installed in a conditioned office space the Second Generation Nonresidential Energy Standards apply. Show LPD complies with the allowed 1.50 watts/ sq. ft. shown on the Certificate of Compliance (CF-1), on lines 30 and 31. The Form 5 is no longer in use for office space and has been replaced by the Lighting Power Demand Delete the Form 5 from the plan and show the LPD on line 30-31 of Certificate of Compliance (CF-1). The Certificate of Compliance (CF-1) must be signed by the building owner and the appropriate California licensed professional(s) showing the license type and number, per the Business and Professions Code Any expansion of an existing HVAC or lighting systeir, for offices, must comply with the Second Generation Non- residential Energy Standards. For office buildings, for which a permit application was made after 1/1/87, provide a plan of the total building showing present use of the occupied spaces, the vacant spaces and indica- ting those spaces that are conditioned or not conditioned to allow checking that the conditioned space(s) have an average lighting power demand within the limits of the prescriptive package selected. Submit a CF-5. See the attached package "Nonresidential Energy Standards applicable to occupancies A,B,E and H. The jurisdiction has contracted with tlsgil Corporation located at 9320 Chesapeake Drive, Suite 208, San Diego, California 92123; telephone number of 619/560-1468, to perform the plan check for your project. If you have any questions regarding these plan check items, please contact at Esgil Corporation Thank you. Enclosures: 3. 0 M Jurisdiction Prepared by i •C^^l VALUATION AND PLAN CHECK ~EE PLAN CHECK NO. $ 1 - I C) 3~ -XT BUILDING ADDRESS 'Zd^ CdttlS T^TL- APPLICANT/CONTACT . BUILDING OCCUPANCY Q 31dg. Dept. D Esgil =~Vr*L 13-tf^-TTZo ^ i C.5 ^r&^.TTw^'-rd-l-h=v2_ PHONE NO. -4-0O ICoS^"" B - 2- DESIGNER PHONE TYPE OF CONSTRUCTION IJ-iJ BUILDING PORTION TX>>T};c,4T?.!Wi On^!^(=r<, *• fl F'P i C. f^ if-.^^ ,5- r\ K! /A/ltt-^g- iVl^Jl-A Air Condi tionins Commercial Residential Res. or Comm. Fire Sprinklers EUILDING A?E.^ cTj ^5 L^T^^ Xf^tj _^^**T^ (^^ ^"3 <^1^ <£- ' (^zp5 ^ ^2&* - fj dJ /4^^. f ,- *^ \ ^^iA£.te.$ -NJD ^f CONTRACTOR VALUATION MULTIPLIER ^ C30 •Z8>2<? ft, °^} , l±f +. > ^- -»- ^ /J^^ @ 0 e PHONE VALUE ^- Ar^rf^Cs ^ ^- 1 o^s\^r ^' 4f\ 1 i^ - XT - ^# vT^> i ^ ^-— • i Total Value \\j^r^ f Fee Adjusted To Reflect D Energy Regulations (Fee x 1.1) Q Handicapped Regulations (Fee x 1.065) ^^^^^ I ^\ "^^^^^^? Building Permit Fee S M~ ^&< ^5 O^-- ]^O /\ S Plan Check Fee S O O 5^S t^ *2^^/0 ^^l— -. /S -^ ^ (// 1 C 0 H MC N TS '1 Illi,I'm 6/4/82 PLAN CHECK NO. ZONE: <D5a; ><u01 TYPE OF PROJECT AND USE;-.«. .-TT r ,. . — -r~ SCHOOL DISTRICT: SAN DIEGUITO ENCINITAS tARLSBAD />< SAN MARCOS SETBACKS: FRONT OV^ SIDE £)Y__ REAR DISCRETIONARY ACTIONS:_ REDEVELOPMENT PERMIT REQUIRED: LANDSCAPE PLAN COMMENTS: ENVIRONMENTAL REQUIRED: COASTAL PERMIT REQUIRED: YES ADDITIONAL COMMENTS: *to OK TO ISSUE;DATE: 0) a; •M 03a DD_ x(j0)r c «"« <A™ a; X 01 01 O E a.a 5 —a ENGINEERING LEGAL REQUIREMENTS LEGAL DESCRIPTION VERIFIED?_ EASEMENTS;, fjlfl. nVprt^vNC/ EDL APN CHECKED? IMPROVEMENTS; [\)[Q RIGHT-OF-WAY ; DRAINAGE; FIELD CHECK DATE & INITIALS: PERMITS REQUIRED GRADING: DRIVEWAY .- MIA GRADING COMPLE. INDUSTRIAL W, ££fiIIFIEp: l 7 FEES REQUIRED PARK-IN-LIEU QUADRANT: '.F.F.: /// , FEE PER UNIT: TRAFFIC IMPACT FEE PER UNIT: FACILITIES MGMT. FEE; SEWER FEE (CONNECTION); BRIDGE & THOROUGHFARE FEE: SEWER LATERAL: ADDITIONAL COMMENTS; .-3 Q OK TO ISSUE:_ DPD2:DP06:10/24/86 DATE: 1200 ELM AVENUE CARLSBAD, CA 92008-1989 TELEPHONE (619)438-5523 Citp of Cartefcafc FIRE DEPARTMENT PLAN CHECK REPORT PAGE 1 APPROVED DISAPPROVED PLAN CHECK# PROJECT ARCHITECT OWNER OCCUPANCY /?-* ADDRESS ADDRESS .ADDRESS CONST S'SPRINKLERED ^TENANT IMP \/~A/TOTAL SO FT / /i/09/)/ _ PHONE _ PHONE STORIES APPROVAL OF PLANS IS PREDICATED ON CONFORMING TO THE FOLLOWING CONDITIONS AND/OR MAKING THE FOLLOWING CORRECTIONS 1 2 3 4 V 9 !_10 11 X" 12 PLANS, SPECIFICATIONS, AND PERMITS Provide one copy of floor plan(s), site plan, sheets Provide two site plans showing the location of all existing fire hydrants within 200 feet pf the project Provide specifications for the following Permits are required for the installation of all fire protection systems (sprinklers, stand pipes, dry chemical, halon, CO2, alarms, hydrants) Plan must be approved by the fire department prior to installation The business owner shall complete a building information letter and return it to the fire department FIRE PROTECTION SYSTEMS AND EQUIPMENT The following fire protection systems are required 0, Automatic fire sprinklers (Design Criteria A/foffi /3 C£rs\T€ us£) ) D Dry Chemical, Halon, CO2 (Location ) D Stand Pipes (Type ) D Fire Alarm (Type/Location ) Fire Extinguisher Requirements II One 2A rated ABC extinguisher for each extinguisher not to exceed 75 feet of travel D An extinguisher with a minimum rating of . sq ft or portion thereof with a travel distance to the nearest _ to be located D Other 8 Additional fire hydrant(s) shall be provided . EXITS Exit doors shall be openable from the inside without the use of a key or any special knowledge or effort A sign stating, " This door to remain unlocked during business hours" shall be placed above the mam exit and doors EXIT signs (6" x 3A" letters) shall be placed over all required exits and directional signs located as necessary to clearly indicate the location of "exit doors GENERAL Storage, dispensing or use of any flammable or combustible liquids, flammable liquids, flammable gases and hazardous chemicals shall comply with Uniform Fire Code Buildmg(s) not approved for high piled combustible stock Storage m closely packed piles shall not exceed 15 feet in height, 12 feet on pallets or in racks and 6 feet for tires, plastics and some flammable liquids If high stock pil- ing is to be done, comply with Uniform Fire Code, Article 81 14 Additional Requirements _ 7~lo a <~ .15 Comply with regulations^on attached sheet(s) Plan Examiner-Date- Report mailed to architect . Met with .Attach to Plans COMMERCIAL/INDUSTRIAL APPLICATION FORM FOR INDUSTRIAL WASTE DISCHARGE PERMIT CITY OF CARLSBAD APPLICATION: NEW (CHECK ONE) REVISED BUILDING P.C. N0.:_ APPLICATION NO.: INDUSTRIAL CLASS: DATE; 5"-/g-37 Signature of City Representative RICH APPLICATION FOR INDUSTRIAL WASTE DISCHARGE PERMIT ,- A. GENERAL: APPLICANT: Z_ I A// o SITE ADDRESS:C& ft TYPE OF BUSINESS; A O. CA H APPLICANT'S ADDRESS; R- &j <Lfc 7^3 6 B. WASTES AND PROCESSING: (Check where applicable) Domestic Waste Only Industrial Waste |_| Industrial Waste NOT Discharged to Sewer Discharged to Sewer GENERAL DESCRIPTION OF WASTE (Chemical and Physical Characteristics of proposed waste); GENERAL DESCRIPTION OF PROCESS (If Applicable): C. WASTES TO BE DISCHARGED TO SEWER WASTE: TREATED: (Check One) UNTREATED! QUANTITY: AVERAGE (Daily) MAXIMUM GPD GPD (Gallons Per Day) APPLICANT OR REPRESENTATIVE OF FIRM: T ITLE : (Print) SIGNATURE;DATE: