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Y"5- 15 <br /> _ "4_" "' �[ -- �4P21ICATIOX� .B .SI.NESS-LIGENSE <br /> �' �f �6RI3 JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> JUL 2 2 2015 BUSINESS LICENSE N0._ <br /> 'r[it;;1'it�� <br /> TO BE-CO E TWOGL'$HE APPLICANT PRIOR TO.FILING THE APPLICATION <br /> Business Information <br /> Business Name: D <br /> Business Address: j 1 Cross <br /> DSAMaiilrg Address: '(�0r,�r Bp l.F4 City: 5T -ry State: 64, ZIP:�Iri.2p <br /> Phone#• a�d " �D Assessor ParcelNumber(s): 9 V <br /> Email: I A YA 00 <br /> Other Businesses at this Address; f4eNIEF ` <br /> Previous Business at Address: -'1 n <br /> Description of Business Operation:: 1(,(.�lJa�t O1J SAT' 5 <br /> &PLACAOIEqJ?(Z6V(6g.'r2 4 1,LE51 LC&fffJeG <br /> Type of Organization: Ingle Owner ❑ Partnership ❑ Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: Estimated Number Of Part Time or Seasonal Employees; <br /> Applicant Last Name: (�f �(1„ Applicant First Name: f <br /> -Applicant Mailing Address:Pp, R4 <br /> . Qty STO�/{p StateC , ZIP Applicant-Phone No: �../r�!J- <br /> WaterSupply. ublic ❑ On-sits Well_ SewageDisposal: ❑ Public ❑ Septic System <br /> Will there be any safe or------ ❑ Yes ,.—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 Date: <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 Signature: � �_21..,�c <br /> STAFF USE ONLY 7 <br /> GIP Designation: Zoning: Use Type: Kv .S •r'S BSc/f//cG R�. <br /> DEPARTMENT APPROVED DENIED AT <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden �( <br /> Public Works <br /> M.H.OS.D. <br /> License Approved For. <br /> Remarks: <br /> J Occ..Grp. <br /> Accepted as Complete: Date: <br /> F/ApplimtonsFormsbHandouts/PlanningApplimtionsBusiness License(Revised 02-2415) <br /> Page 2 of 6 <br />