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APPLICATION - BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> y: :< <br /> BUSINESS LICENSE NO. Y�L ' 1 ;)OL <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: A S�-`-(� c-- <br /> Business <br /> _Business Address: 3cl 3 \j (.c)4) 6ross St . <br /> DBA Mailing Address:TO City:, m',10 ` a State: C-Ift I ZIP:9 <br /> Phone#: - Z.S� \ Assessor Parcel Number(s): 0 5IR I t u5 3 <br /> Email: 12 U Cl <br /> Other Busines es a Address: (:Dr)<\-Y\)C-A4-011. <br /> Previous Business at Address: <br /> Description of Business Operation:: <br /> J <br /> Type of Organization: ❑ Single Owner �/-❑ Partnership Corporation ❑ Other: OFFICEr"v NApA COUNLI <br /> Estimated Number of Full Time Employees: _17 Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: e d Applicant First Name: <br /> Applicant Mailing Address: p' Ov <br /> City Wpc � StateGjk ZIP S Applicant Phone No:�'Z,p <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 proceed g gainst the County <br /> arising from the Ow er/A ant' project. <br /> r <br /> Applicant's Signature: <br /> STAFT USE'ONL <br /> G/P Designation:) � A C Zoning: Use Type: M <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: C <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: (� <br /> Occ.Grp. <br /> Accepted as Complete: Dale: <br /> F/ApplicalionsFonns&Handouts/PlanningApplications/Business License(Revised 11-14-11) <br /> Page 2 of 6 <br />