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APPLICATION -- BUSINESS LICENSE <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />BUSINESS LICENSE NO. BL— (70-9Z9 It <br />TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br />Business Information <br />Business Name: L.4 <br />Business Address: q 6 9•^ L <br />DBA Mailing Address: �{ Cfty; State: ZIP: 19 0l <br />Phone#: Z s?- 63%_czoz4 Assessor Parcel Nu bsr(s): Zke D - <br />Email: b p a <br />Other Businesses at this Address; '1� <br />Previous Business at Address: YIAni e I I. c T rte. <br />Description of Business Operation:: ('x1:0. Vc,% r 4 r MEO LG k! c <br />Type of Organization: ❑ Single Owner OR Partnership ❑ Corporation ❑ Other, <br />Estimated Number of Full Time Employees: <br />Estimated Number of Part Time or Seasonal Employees: 1 <br />Applicant Last Name: RNA+J <br />Applicant First Name: W i L44 4j 1 <br />Applicant Mailing Address:'90p Z PZ5 o T,?Ac-%f G4 S3 <br />City "rfjh G State CA ZIP <br />Applicant Phone No: Zjdj— ff3 J _ o0 Ze, <br />Water Supply: INPublic ❑ Onslte Well <br />Sewage Disposal: ® Public ❑ Septic System <br />Will there be any sale of firearms? ❑ Yes Q 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 <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 />Appllcant6 Signature: �Jz <br />Date: <br />�% a <br />STAFF USE ONLY <br />GIP Designation:Zoning: Use Type; <br />DEPARTMENT APPROVED DENIED DATE <br />Development Services Planner Name: CQ, ZP ( ) <br />Building Inspection <br />Environmental Health Div L v — -S / <br />Fire Warden <br />Public Works <br />M.H.C.S.D. <br />License Approved For C , �'�� G1 �r C1. •. j( — <br />Remarks: 4SL—ILI 00 <br />Occ. Grp. <br />Accepted as Complete: Date: <br />F/ApplicallonsForms&Handouts/PlanningAppCcafions/Business License (Revised 02-24-15) <br />Page 2 of 6 <br />