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t4T�„Cp` <br />v <br />APPLICATION - BUSINESS LICENSE <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />R.L. NO. <br />RECEIPT NO. <br />ANNUAL FEE: <br />BwMen Name: %E'6� ' v ` G✓f,C DBA(f dMsrenq: z <br />Buslmss Address: S L[ ! <br />Other Businesses W this Address: <br />Phone: Z- O tj 5 / E .t , ,2 Auseeor Parwl Number(s): %�— O� <br />Meiling Address: <br />type of Business: �(' ,9�iV L <br />Type of Oigsnizellon: ❑ Single Owner O Padnerehlp CF16orporetlon ❑ Other: <br />Esllmeled Number of Full Time Employees: 1-1) EsBmeted Number of Pad Time or Seasonal Employees: <br />Business Owmr(s) Na..: n� /L �� <br />Business Ownsr(s) Address: /fj /i�G r✓ % t E <br />Manager's Name: �- c � v j <br />Previous Business al Buslness Addmssf <br />Other Local Buslnese Locations (Address): <br />Water SuppM: ❑ Publlc mp-On-she Well Sewage Disposal: ❑ Public O -Septic System <br />W... there be any retell sales of pistols, revolvers or other ooncealable hrserms4 ❑ Yes 13"oNOTE: ANY CHANGE OF PORUIPANCY WILL REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMRS. <br />Appllcenl's Signelure: 9/J �� Date: /-/7 <br />Copies: WHRE-Development, GREEN -Building, CANARY -Fire DIe1rIet PINK-EWmmentel Heehh, GOLDENROD-APCD <br />PA_BLLG Rev. <br />