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RECEIVED <br /> ��y APPLICATION — BUSINESS LICENSE <br /> �m unity Development `b0. OAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> F,'i:IlC:I'1C. Planning ' lk—�T <br /> BUSINESS LICENSE NO. <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: r <br /> Business Address: I Cross St <br /> DBA Mailing Address: CW --LDAe State: ZIP:q Q <br /> Phony#: Assessor Parcel Number(s): Acl llu - <br /> Email: LO 121G ylnGl I�.CD kr� <br /> Other Businesses at this Address: <br /> Previous Business at Address: to WtO- — e/r, <br /> Description of Business Operation:: Pra4 — F0-14-, <br /> 71iC noullircIgIlAn <br /> Type of Organization: Ingle Owner ❑ Partnership ❑ Corporation ❑ Other: Cy SE QE$ <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: -7 <br /> Applicant Last Name: Ale k e,-- Applicant First Name: 001171f <br /> Applicant Mailing Address: 70' Q <br /> Ci State ZIP Applicant Phone No: <br /> Water Supply: Rtublic ❑ On-site Well Sewage Disposal: ublic ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes }-rJo <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/ ent's pro'I e-co <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> G/P Designation: l Zoning: Use Type: �� J -, 1 J,U <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health ON <br /> Fie Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For. <br /> Remarl s: I <br /> .l <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F OevSvcWlanning Appllcabon Forms\Business License(Revised 01-2510) Page 2 of 7 <br />