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APPLICATION - BUSINESS LICENSE <br /> ).•T'' <br /> r.� y SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> N; < <br /> BUSINESS LICENSE NO. I I <br /> � -1 <br /> trFOR� <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information C <br /> Business Name: <br /> Business Address: ,50tW ��{}� � -('.eP� Cross St C C-\SY1VvA\GiM <br /> DBA Mailing Address: O M- Ta-p--,A e1JA City: State: Cj} ZIP:q Sia <br /> Phone#: $ 500(o t Assessor Parcel Num er(s): c' - (7 1 U-0 t—j <br /> Email: 6-v, iflA 6l- (2 Gs,�oeo. c-on <br /> Other Businesses at this Address: 1.4 Q <br /> Previous Business at Address: V A vr- \k" <br /> Typeof Business: 4sce .eko k es-J\c-e <br /> Type of Organization: ❑ Single Owner ❑ Partnership I[.I Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name Applicant First Name: <br /> Applicant Mailing Address: C <br /> City State ems— ZIP,?Y-7Applicant Phone No: Z-->'v <br /> Water Supply: ❑ ublic On-site Well Sewage Disposal: ❑ Public Septic System <br /> Will there be any sale of firearms? ❑ Yes 114 No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> 1,affirm, under penalty of perjury that all the above information is true and correct Date: <br /> I,the Gwrter/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 Gwner/Agent's pr <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> G/P Designation: Zoning: Use Type: <br /> DEPARTMENT APP VED DENIED DATE <br /> Development Services Planner Name: "l I <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For <br /> 5 <br /> Remarks: z t w A.Sey J I ce C1-- ' U •� a- �%U1'. '{ <br /> .6 rd !^ <br /> h\i)(e- I h e-y\5, g4-, C4Jt-u r5 (, g, S Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:\DevSvc\Planntng Application Forms\Business License(Revised 11.16.09) Page 2 of 7 <br />