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I-VP- <br /> APPLICATION - BUSINESS LICENSE <br /> x06��'-So <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> :i <br /> BUSINESS LICENSE NO. oU 3-3 a' <br /> ;w <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: 6/K Lqj� F41ii40 <br /> Business Address: 17,7/5' S.M( #j 1- Cross St (,p <br /> DBA Mailing Address: I-L IS 5, 1w U City: (�- P State: ZIP: <br /> Phone#: Z41- - 1,5,00 Assessor Parcel Number(s): <br /> Email: d T A. CAS <br /> Other Businesses at this Address: t& f at SAL n I e <br /> Previous Business at Address: f,} A <br /> Type of Business: W S Q 1 0ir� p <br /> Type of Organization: ❑ Single Owner Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: Q Estimated Number of Part Time or Seasonal Employees: 3 <br /> Applicant Last Name: I, Applicant First Name: <br /> Applicant Mailing Address: k1:45 , ►►�/k^1 <br /> City P F State CA I ZIP 103 0 Applicant Phone No: UY-13f-/500 <br /> Water Supply: ❑Public PQ On-site Well Sewage Disposal: ❑ Public 90 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 /> f, affirm,all the above informat' true and correct Date: Z <br /> Applicant's Signature: N^_Dg, <br /> STAFF USE ONLY <br /> GIP Designation: L Zoning: - " I S I Use Type: �' Q l - <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: Ww 4008 <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> Sheriff(Junk Dealers Only) <br /> License Approved For: 'S a—k.e ci i S d ./ <br /> Remarks: Q0-706>31 S� <br /> Uv a <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:IDev5vc\P1anning Application FormskBusiness License(Revised 01-16-08) Page 2 of 8 <br />