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s _ <br /> p4�1" APPWATION — BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. UU 3 'a.2— <br /> r'd(ikoP`'P • , V <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> [Email: <br /> iness Name: <br /> v <br /> iness Address: t(q 11 N,Nd (,gip 9,5 a Cross St KGTe C NEN LANE <br /> A Mailing Address: 3 QrStiC t,J�S{v.t. City: iMy ; State: (A ZIP: I S 1 <br /> ne u: e 6 — $SS3 Assessor Parcel Number(s): O Z <br /> Other Businesses at this Address: M 50 AIJ T kC <br /> Pr <br /> Previous Business at Address: s M <br /> Type of Business: 4h< O <br /> Type of Organization: ❑ Single Owner ❑ Partnership ❑ Corporation Cher: L 2—G <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: Applicant First Name: M I tj <br /> Applicant Mailing Address: 0'0 W _ 7 0 N y <br /> cityISL:SiTo Stale ZIPq S Applicant Phone No 10,0 <br /> Water Supply: ❑Public to On-site Well j Sewage Disposal: ❑ Public JU 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 /> I,affirm,all the above information is true and correct Date: <br /> Applicant's Signature: AL 11 1,017 <br /> STAFF USE ONLY <br /> G/P Designation: Zoning: ' Use Type: fen <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services ✓ Planner Name: to,-L9-7 <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: 61nSaifiiiLw C CA, t <br /> Remarks: <br /> Cl «/-> ' Occ.Grp. <br /> Accepted as Complele: Date: <br /> F:\DevSvc\Planning Application Forms\Business License(Revised 0e-21-07) Page 2 of 7 <br />