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f <br />--ILfj b <br />APPLICATION - BUSINESS LICENSE <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />BUSINESS LICENSE NO. �L_ " I p V ()�g <br />TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br />Business Information <br />Business Name: N d 1 v\ci <br />Business Address: � k Lk ` _� C Cross St <br />DBA Mailing Address: gzzz tvl'�Q V) City; 0,j'f'-(.� (r Ig- <br />State: tg <br />ZIP: Z,Og I <br />Phone #: %(On -C' �— Z3y Assessor Parcel Number(s): <br />Email: K , � m <br />, <br />Other Businesses at this Address: nJ y <br />Previous Business at Address: <br />Description of Business Operation:: <br />Type of Organization: ❑ Single Owner ❑ Partnership Corporation ElOther: <br />Estimated Number of Full Time Employees: (, Estimated Number of Part Time or Seasonal Employees: <br />Applicant Last Name: H O <br />Q% Applicant First Name: <br />Applicant Mailing Address: <br />A"qv, <br />City%kqnt) ixflu <br />- State i. ZIP Cf2oj <br />Applicant Phone No: <br />Water Supply: []Public ❑ On-site Well <br />Sewage Disposal: a 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 />1, affirm, under penalty of perjury that all the above information is true and correct <br />I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its <br />agents, officers and employees from any ci urn, action or proceeding against the County <br />arising from the Owner/Agent's project. <br />Applicant's Signature: <br />Date: <br />3-2Z-1 C' <br />STAFF USE ONLY <br />G/P Designatbn:( <br />ZoninZ- — <br />< Cig: <br />Use Type: [;'O,� J ru <br />r ViY CPS <br />DEPARTMENT <br />APPROVED DENIED <br />DATE <br />Development Services <br />Planner Name: i- y <br />Building Inspection <br />Environmental yealth Div <br />Fire Warden <br />Public Works <br />M.H.C.S.D. <br />License Approved For: <br />rn o <br />Remarks: <br />Occ. Grp. <br />Accepted as Complete: <br />Dale: <br />F/ApplimbonsFonns&Handouts/PlanningApplicationsBusiness License (Revised 02-2415) <br />Page 3 of 6 <br />