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(t/;28/aJI~ <br />D;:J011'1C0Cl LI\..,CI'IIC>C I'IU . <br />TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br />Business Information <br />Business Name: Ford Construction Company Inc. <br />Business Address: 12505 E . Brandt Rd . Cross St Hwy88 <br />DBA Mailing Address: 300 W . Pine St. City: lodi I Statt~· Ca -I ZIP: 95240 <br />Phone#: 209 .333-1116 Assessor Parcel Number(s): 0 }-/ 12.0.:; I 0 <br />Email: admin@ford-construction .com <br />Other Businesses at this Address : KeiJo_g_g Garden Products , Meza Trucking , Winn Trucking <br />Previous Business at Address: Winn Trucki nq <br />Description .of Business Operation:: Construction Yard , AC & Concrete recycling, AC plant (m anufa cturing), concrete batch <br />plant fm a nufacturing), and agg reg ate stockpi les <br />Type of Organization : 0 Single Owner 0 Partnership [)(1 Corporation 0 Other. <br />Estimated Number of Full Time Employees : 4 Estimated Number of Part Time or Seasonal Employees: 1 0 <br />Applicant Last Name: Jones Applicant First Name: Nicholas B. <br />I Applicant Mailing Address : 300 W. Pine St. <br />City lodi State Ca Z IP 95240 Applicant Phone No: 209 3 33-1 116 <br />Water Supply: 0Public 1)0 On-site Well Sewage Disposal : 0 Public ~ Sepiic System <br />Will there be any sale oi firearms ? 0 Yes lXl No <br />NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br />I, affirm , under penalty o f perjury th a t all the a bove information is true and correct Date : <br />I, the Owne</Agent ag~ to defe nd, ~~~ hold !mnnles. the County aod Its <br />agents, office« and e~!' from an cl~, action o< p <oceedlng against the County <br />ar1sing-from the Owne g nfs projec <br />Applicant's .Signature : ~ b·\-\~ <br />·' \~ STAFF USE ON LY <br />' <br />G/P Designation : z= I c-f i:./ :.zoning: L--'-7 '1::: f.-Use Type : ~:· ~ 'i!ll "-1./ .J:JJ_f./i-1 ... -Jj,: .-..-/ _ r.,. l.-2 / .n t>.-1 <br />DEPARTMENT APPROVED DENIED ;1 .! DATE J <br />Development Services 1./ Planner Name: 1~ 6/lt.U,-' 6 1 1 ~/J'i- <br />Building Inspection (., I I <br />Environmental /'lealth Div / fW\-\\U ~ 0 l1'Q2'6 w IJ.-111 l6 <br />Rre Warden Vlo~ ltliVItlP. <br />Public Works <br />M .H .C.S.D. <br />License -Approved For: <br />h C'1._ f-e-A. r:J I Cf" f-e 0/'1 {/'I?. { ~ f C'l,c:;· .oA c../ f T~<-L/ r!t.~c, <br />Remarks: <br />I -' <br />.... ) ~-<: U1 f -06 -0 12-7 <br />0. s A__l e 1 / f-oC-~A ,--; C' r ..,,. f e [-<> L '-c (;~ c~ Occ. Grp . <br />Accepted a~ Complete: <br />~ ..J Da te: <br />F/ApplicationsForms&Handouts/PianningApplications /Business License (Revised 02-24-15) <br />Page 3 of6 REC IV D <br />JUN 1 3 2018 <br />ENVIRON MEN TAL HEALTH <br />PERMIT/SERVlCES