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10 <br /> oe.4 t" APPLICATION - BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> N l t BUSINESS LICENSE NO. I IV��O 4' <br /> rFOR <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> / Business Information <br /> Business Name: ZC D 6U pP I-/ nG <br /> Business Address:22 50 5 Tau-bf-T ST *9cross St ��ifl(✓t71 � <br /> DBA Mailing Address: City: 5�C✓l ^ <br /> State: cam' ZIP:gS2Dj <br /> Phone#: a�-q q 3- .452 Assessor Parcel Number(s): I q O'BO- 2 Z <br /> Email: I rno+tOeC acWJI - 2T <br /> Other Businesses at this A dress: rl A <br /> Previous Business at Address: h <br /> Description of Business Operation:: <br /> Type of Organization: ❑ Single Owner ❑ Partnership nl Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: 20 Estimated Number of Part Time or Seasonal Employees: er <br /> Applicant Last Name: -P nV a1 1 Applicant First Name: POW t <br /> Applicant Mailing Address:22-5D 5th r-t- 5T . 49 <br /> City SCI"vy) StateCA I ZIP 9�W Applicant Phone No: 204. Q LJ j 2 4SZ <br /> Water Supply: Public ❑ On-site Well Sewage Disposal: ❑ Public Septic System <br /> Will there be any sale of firearms? ❑ Yes IX 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 Date: <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/ ant's project.. <br /> Applicant's Signature: 1�9lr�iil.e�✓ '�C(L�- L d��1/�L� <br /> STAFF USE ONLY <br /> G/P Designation: Zoning: Use Type: X07\ <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. _J <br /> License Approved For: ^J wD <br /> Rema ks: <br /> JOcc.Grp. <br /> Accepted as Complete: Date: <br /> F:\DevSvc\Planning Application Forms\Business License(Revised 01-25-10) Page 2 of 7 <br />