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10 <br />1 PqurN � <br />APPLICATION - BUSINESS LICENSE <br />AIM <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />BUSINESS LICENSE NO. & —17 00 a R91 <br />TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br />Business Information <br />Business Name: 5 <br />&A&Al <br />Business Address: <br />Cross St <br />DBA Mailing Address: sr•"rN aR 9S'--, <br />City O Cr d <br />State: Coq- <br />ZIP: <br />Phone #:o t /IC 0 � <br />Assessor Parcel Number(s): - + <br />Email: <br />Other Businesses at this Address: <br />Previous Business at Address: <br />Description of Business Operation:: <br />Type of Organization: ❑ Single Owner ❑ Partnership Ueldo-rporation ❑ Other. <br />Estimated Number of Full Time Employees: <br />Estimated Number of Part Time or Seasonal Employees: <br />Applicant Last Name: <br />Applicant First Name: +' <br />Applicant Mailing Address: / V p r T <br />Citycm G <br />State ZIP Q�31C <br />Applicant Phone No: <br />Water Supply. [)Public ❑ On-site Well <br />Sewage Disposal: ❑ Public ❑ 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, under penalty of perjury that all the above information is true and correct <br />1, 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/Agents project: <br />Applicant's Signature: <br />Date: <br />STAFF USE ONLY <br />G/P Designation: 3C! 6,- Zoning: - G Use Type: 7 % u C o /e-fVO <br />CA I !- <br />DEPARTMENT APPROVED DENIED <br />DATE <br />Development Services Planner Name: 22 <br />Building Inspection <br />Environmental Health Div ✓ 4v - <br />v <br />Fire <br />Fire Warden <br />Public Works <br />M.H.C.S.D. <br />License Approved Fon <br />f u C- n et Y c l Y" <br />Remarks: <br />�e-e S - I % OC O b <br />Occ. Grp. <br />Accepted as Complete: <br />Date: <br />F/ApplicationsFormsBHandouts/PlanningApplicabons/Business License (Revised 02-2415) <br />Page 3 of 6 <br />