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RECEWD APPLICATION — BUSINESS LICENSE <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT <br />OCT 12 2010 BUSINESS LICENSE NO. I W lJ�— <br />Snnl JOAQUIN <br />TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATIUN <br />Business Information <br />,,/ ,,/ <br />Business Name: „Y.t7GEP4 S /K C l SugGfl A/ PJ f Cs <br />Business Address: <br />DBA Mailing Address: <br />Phone #: <br />Cross St <br />City: State: ZIPS'% <br />Assessor Parcel Number(s): Z- u Q - 3 <br />Email: <br />Other Businesses at this Address: <br />Previous Business at Address: <br />Description of Business Operation:: <br />Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other: <br />Estimated Number of Full Time Employees: <br />Estimated Number of Part Time or Seasonal Employees: <br />Applicant Last Name: <br />Applicant First Name: <br />Applicant Mailing Address: Te <br />City l State ZIP <br />Applicant Phone No: Q — 0 <br />Water Supply: Public ❑ On-site Well <br />Sewage Disposal: Public ❑ Septic System <br />Will there be any sale of firearms? ❑ Yes 19 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 <br />1, 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 <br />arising from the Owner/A nt' project. <br />Applicant's Signature: <br />Date: j <br />O� I <br />STAFF USE ONLY <br />G/P Designation: <br />Zoning: <br />Use Type:A'fi ' <br />DEPARTMENT <br />APPROVED <br />DENIED <br />DATE <br />Development Services <br />Planner Name: <br />O EL t7 <br />Building Inspection <br />Environmental Health Div <br />Fire Warden <br />Public Works <br />M.H.C.S.D. <br />License Approved For: <br />Y SDC+✓ C <br />Remarks: <br />LZ <br />Ooc. Grp. <br />Accepted as Complete: <br />Date: <br />F:\DevSvc\Planning Application Foms\Business License (Revised 01-25-10) Page 2 of 7 <br />