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APPLICATION - BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO� ' <br /> C%FO 'A <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: Oo O"T C- ;J C/kVV D ( to 1 Vl <br /> Business Address: ( J Cross St y- <br /> DBA Mailing Address: O �94 Q City: State: ZIP: 9 SZ.-37 <br /> Phone#: 9O - 21 3 3 1-15 1 Assessor Parcel Number(s): <br /> Email: <br /> Other Businesses at this Address: ^10 <br /> Previous Business at Address: <br /> Description of Business Operation:: 'Sik Amm, d` A i N rg A,*ko->c( A1 —,94 <br /> 11-e &-2-d AVCA <br /> Typeof Organization: ❑ Single Owner Partnership El ❑ Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: 7j <br /> Applicant Last Name: C-1 6 wt.Q.Z. Applicant First Name: S ✓7`-� <br /> Applicant Mailing Address: . Q • 5,3y '5-10 <br /> City L_0 L Ik d State Ch ZIP Applicant Phone No: 'Z.0 - 1-75-9' <br /> Water Supply: NfPublic ❑ On-site Well Sewage Disposal: WPublic ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes 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 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/A 7ntroject. <br /> _ <br /> Applicant's Signature: <br /> ST USE ONLY <br /> GIP Designation: Zoning: C-C Use Type: <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div OUt7 s j <br /> Fire Warden o <br /> Public Works S t' <br /> M.H.C.S.D. <br /> License Approved For: - "n"yvir'liv <br /> Remarks—T_' o k v�) <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F\DevSvc\Planning Applicafion Formsl9usiness License(Revised 01-25-10) Page 2 of 7 <br />