Laserfiche WebLink
APPLICATION BUSINESS LICENSE <br /> 2` •y SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> :y <br /> !I ll <br /> BUSINESS LICENSE NO.� L � 3 <br /> 0 BE:COMPLETED BY THE APPLICANT PRIOR TO FILI'NGaTHE APPLICATION <br /> 15 t'YO. t., �, a=} Btasin. Ess Infarmatlort'. 5 <br /> Business Name: aU <br /> Business Address:1` FS Cross St <br /> DBA Mailing Address: City: State: Ca ZIP. <br /> Phone – 5. [� Assessor Parcel Number(s): ` _—S <br /> Email: (;L� <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: <br /> JUN 2 S 2012 <br /> Wapnk Ilk <br /> Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other: HFAL7H DE <br /> Estimated Number of Full Time Employees: 3 Estimated Number of Part Time or Seasonal <br /> Employees: <br /> Applicant Last Name: Applicant First Name: 11 P I Y1-ce r <br /> Applicant Mailing Address: I l �. �� 0 <br /> City State ZIP Applicant Phone Na: <br /> Water Supply: Erp,�blic ❑ On-site Well Sewage Disposal: Public ❑ Septic System <br /> Will there be any sale of firearms?. ❑ Yes VINO <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I, affirm, under penalty of perjury that all above information is true and correct Date: <br /> I, the Owner/Agent agree defend, indemni , and hold harmless the County and its <br /> agents,officers and em o es from any clai ,actio r proceeding against the County Z <br /> arising from the;Ownerl g nt's project. , <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> GIP Designation: Zoning: Use Type: <br /> DEPARTMENTAPPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warde O m>n <br /> Public Works <br /> License Approved For: <br /> Remarks: <br /> L 1/2 t 0 Occ.Grp. <br /> Accepted as Complete: Date: <br /> FlApplicationsForms&Hand outs/PlanningAppiications1Business License(Revised 11-14-11) <br /> Page 2 of 6 <br />