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APPLICATION - BUSINESS LICENSE SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT BUSINESS LICENSE NO. & —1'300 1 L' 3 TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION Business Information Business Name: U f.? Business Address: ScLv11C,JO Y,4 Cross St (:j t1k, DBA Mailing Address: / x City bState: C zl" j b9 . Phone 2p S� (p Assessor Parcel Number(s): D 13 " L -C " Z�' Email: , r Other Businesses at this Address: A/D V1 . V Previous Business at Address: A C Description of Business Operation:: &(pC'W DEPARTMENT Type of Organization: []'Single Ovwner ❑ Partnerships ❑ Corporation ❑ Other. Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: Applicant Last Name: Applicant First Name: 1 ' -Applicant Mailing Address: c, rc , 5 _ Ci s r) I State L v� ZIP ' i/ Applicant -Phone No: 2O iv q & b —1 t Water Supply. PPublic ❑ On-site Well Sev/age Disposal: ❑ Public 2 -Septic System Will there be any sale of firearms? ❑ Yes V1170 NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. I, affirm, under penalty of perjury that all the above information is true and correct I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its agents, officers and employees from any claim, action or proceeding against the County arising from the Owner/Agent's project. Applicant's Signature: Date: X STAFF USE ONLY 6P7=n: C IKS Zoning: -Y2_5 Use Type: 1LrZ�;�� 7�•� C_ 1, DEPARTMENT APPROVED DENIED DATE Development Services LlPlanner Name: Building Inspection Environmental Health Div Fire Warden Public Works M.H.C.S.D. License Approved For.p, n r � _ C (: �. c y � -'I Remarks: ,TCA oi %L--j�y1 1 6L �i rl •; iv Occ. Grp. Accepted as Complete: Date: F/ApplicationsFonns&Handouts/PlanningApplicationsBusiness License (Revised 02-2415) Page 2 of 6