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CEIVED <br />AUG 2 8 2017 <br />APPLICATION — BUSINESS LICENSE <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />BUSINESS LICENSENO.(3L-- 1%eDIq <br />TOB HE APPLICANT PRIOR TO FILING THE APPLICATION <br />Business Information <br />/� <br />Business Name: P C,Ftc Q Pentcds, k4C <br />Business Address: 35YO E Caepenter,crossst 99 Fronfa e- Rd. <br />o p/ <br />OO pto city: I;(1(a rj <br />DBA Mailing Address: 0 0 Pc� <br />State: C/q ZIP: QI <br />OcE <br />Phone #: 3 - 7�H - O p ( Assessor Parcel Number(s): 1-79— 16o- q7 <br />Email: IOCQI: bad oweer� ac�f�ca rentor( .can <br />Other Businesses at this Address: (rl 0. <br />Previous Business at Address: /4 - <br />Description of Business Operation:: u; m enf Sq(e5 Fc,rm Aock'n r <br />Type of Organization: ❑ Single Owner ❑ Partnership ❑ Corporation JR Other. 4 L•C, <br />Estknated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br />Applicant Last Name: glke(` Applicant First Name: ot rt Ie <br />/ /J�1 <br />Applicant Mailing Address: gX Pare 1100 -f+�1 9 <br />City l�y)GS State CA 1 ZIP 901 <br />Applicant Phone No: <br />Water Supply: []Public ® On-site Well <br />Sewage Disposal: ❑ Public 0 Septic System <br />Will there be any sale of firearms? ❑ Yes X No <br />NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br />I, affirm, under penalty of perjury that all the above information is true and correct <br />I, the Owner/Agent agree, to defend, Indemnify, and hold harmless the County and its <br />agents, officers and employees from any claim, action or proceeding against the County <br />arising from the Owner/Agent's project. <br />Applicant's Si re: <br />Date: 3/i0/17 <br />STAFF USE ONLY <br />GIP Designation'. L.-. Zoning: - j_ Use Type: tA.l -� t � S 1✓ - �0.y'YY1 <br />DEPARTMENT APPROVED <br />DENIED MatcVui�.r DATE <br />Development Services ,� <br />Planner Name: Z — <br />Building Inspection <br />Environmental Health Div ✓ Il{ I •-t /1 <br />111 -7 <br />Fire Warden�G♦'�, <br />Public Works <br />M.H.C.S.D. <br />(Q <br />License Approved For. A, <br />Remarks: <br />3l �30013a 5A _ 01-00r 2 <br />Occ. Grp. <br />Accepted as Complete: <br />Date: <br />F/ApplicationsForms&Handouts/PlanningApplications/Business License (Revised 02-24-15) <br />Page 2 of 6 <br />