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aP4 +n. APPLICATION — BUSINESS LICEIRE EIVED <br /> a• •.ate <br /> c:' •,y SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. Jt dOB FEB 2 4 2011 <br /> CARI•YrFOR�' UIN COUNTY <br /> GENCY SERVICES <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: C r L(_ �-- <br /> BusinessAddress: 25 Ste( °pper •,n jr�lu�)< r^'Y Cross St <br /> 1 LCj� <br /> DBA Mailing Address: A U , Uag $' t0 City: 0 a II t r( State: (' T ZIP: (Xraj <br /> Phone#: Z of—2l n 2�Y9 Assessor Parcel Number(s): <br /> Email: a lS C r Rh y µ <br /> Other Businesses at this Address: 1 T <br /> Previous Business at Address: A, e aC� 17 r(.I 1 Ac <br /> Description of Business Operation:: <br /> A0(CSOL D. f,,bIf11 C C{Ar ) Tor-- <br /> Type <br /> o r <br /> Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: t{Q Estimated Number of Part Time or Seasonal Employees: So <br /> Applicant Last Name: Wi'l IS Applicant First Name: M�L Ae- <br /> Applicant Mailing Address: r ff� Q o L L L f,0 , a X T'10 <br /> City we kl.0r State (,= ZIP OC88 Applicant Phone No: 103 — 6 Z TUO <br /> Water Supply: []Public ❑ On-site Well 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 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 2_/7 Z <br /> arising from the Owne A ent's„proj t. / <br /> Applicant's Signature: <br /> STAFF USE ONLY y <br /> G Designation: Zoning: L Use Type: t 1 6 <br /> DEPARTM T APPROVED DENIED DATE <br /> Development Services Planner Name: Z <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For. <br /> Remarks: S �.•}"��^ a na-G <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:10evSvc\Planning Application Fonns\Business License(Revised 01-2610) Page 2 of 7 <br />