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%'t✓� SF 31 , a010 <br /> APPLICATION -'BUSINESS LICENSE <br /> P , SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEITIT\� <br /> 1� %! BUSINESS LICENSE NO. <br /> \a <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO'FILINEG THE APPLICA <br /> Business Name: t 4(1� d 5.4�LNe. <br /> Business Address: %yam 9 o S . v'.KLL--"-Jo CT Cross St WoI74 12-D <br /> OBA Mailing Address: p S. A. GT- City: FF'c'tiCN CA-..Jj I State: GT ZIP: 9XZ31 <br /> Phone#: e,.o! 5 d'J-F8 c r Assessor Parcel Number(s): q <br /> 14C CLA <br /> Email: <br /> Other Businesses at this Address: Al . <br /> Previous Business at Address: <br /> Description of Business Operation:: <br /> Type of Organization: ❑ Single Owner ❑ Partnership 29 Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: %S Estimated Number of Part Time or Seasonal Employees: Al r <br /> Applicant Last Name: Applicant First Name: - ♦✓-� <br /> Applicant Mailing Address:41125 [, LAV' \wAA A.fE. *2-So <br /> City AomAclK I State C.A. ZIP q 'f. Applicant Phone No: 914--9,15- Z-24-— <br /> Water Supply: ',Public On-she Well Sewage Disposal: Public ovseptic System <br /> Will there be any sale of firearms? ❑ Yes m 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 Owner/Agent's project. <br /> Applicant's Signature/ )D4- [ v,r _r%v c. . <br /> STAFF USE ONLY <br /> G/P Designation: Zoning: ' /L Use Type: _ �� �� <br /> i VxW J}2 <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden EL <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: <br /> Remarks: <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br />