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APPLICATIO BUSINESS LICENSE <br /> . I -...., <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> s <br /> ' BUSINESS LICENSE NO. V ✓ IZ" I� <br /> TO BE;COMPl:ETED BY THE APPLICATIT PRIOR'�'TO FILING,THE APPLICATION <br /> Business Infbrmatla <br /> Business Name: <br /> Business Address: t ArVE Cross St <br /> DBA Mailing Address: GSC) vLr I City: S r-14OVN I State: (,(4 ZIP: Cl VIT <br /> Phone#: p II Assessor Parcel Number(s): 113 <br /> Email: r r r •t v <br /> Other Businesses at this Address: <br /> Previous Business at Address: C ./may/' 6"-0 ACS( e' <br /> Description of Business Operation:: 2012 <br /> VIRO <br /> DEPggTMEV 1-AAL <br /> NT <br /> Type of Organization: ❑ Single Owner M Partnership ❑ Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: Z, Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: � Applicant First Name: L .�— O <br /> Applicant Mailing Address: ,n <br /> City S State C A, ZIP - Applicant Phone No' Q q C1. t <br /> Water Supply: EfPublic ❑ On-site Well Sewage Disposal: 9 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: 0 /20 <br /> I, the Owner/Agent agree,to defend,indemnify, and hold harmless the County and its r <br /> agents, officers and employees from any claim, action or proceeding against the County <br /> arising from the Owner/Agent's project. <br /> Applicant's Signature: <br /> STAFF USE ONLY - <br /> G/P Designation: Zoning: rr V Use Type: t' l5 (n r L <br /> DEPAR' MENT APPR ED DENIED DATE <br /> Development Services Planner Name: i <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For. tjL (i I k-zl ('d 1 U-5 -� V V\ <br /> Remarks: )✓ L� <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicationsFortns&Handouts/PlanningApplirations/Business License(Revised 11-14-11) <br /> Page 2 of 6 <br />