Laserfiche WebLink
F{ECEIVED <br /> JUL 9 - 2010 <br /> C4, <br /> APPLICATION — BUSINESS LICEN e oulN couNrr <br /> SAN JOAQUIN COUNN COMMUNITY DEVELOPMENT DEP EM RGENCYSERVICES <br /> BUSINESS LICENSE NO. (X 1U �4O� <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: iIa4Tri lCera 'r-*L>ll <br /> BusinessAddress:15Z5 Cross St <br /> DBA Mailing Address:pO,3otc 014111 .T x City: Khexvi like— State:TIy <br /> Phone* ($(0,$)58$--1y$$ Assessor ParcelNumber(s): 0251 pky <br /> Email: d0.Ji�l, erikeV•,a® L I eh�'e'r'S.coVv. <br /> Other Businesses at this Address: „pne <br /> Previous Business at Address: i T <br /> Description of Business Operation:: k -� <br /> Type of Organization: ❑ Single Owner ❑ Partnership ❑ Corporation Mother.L•v'N'I•ul.L�d0i1�� Cor.. <br /> Estimated Number of Full Time Employees: zi I Estimated Number of Part Time or Seasonal Employees: ` <br /> Applicant Last Name:p;1aV7ro..ve1Cev4ers LLC Applicant First Name: <br /> 7� <br /> Applicant Mailing Address: .O,"Gox 1014h i � 'I' <br /> City y� •k C State'[ ZIP Applicant Phone No: 865 SSS-1 O <br /> Water Supply: %Public ❑ On-site Well Sewage Disposal: X Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes A 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 proceeding against the County <br /> arising from the(Tuner/ ntIsp ' ct. f4liclnell D. S}eehrodr SVP&CFO <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> GIP Designation: f Zoning: Use Type: r,�ce ,Sq/,•T s. fo'vie v - 1 i f 4�p <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: 12G 7 17h tj <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: Date: <br /> F:\DevSvcWianning Application Forms\Business License(Revised 01-2670) Page 2 of 7 <br />