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oP°SIN•-c <br />. 5 /i- �1"-)ae <br />APPLICATION - BUSINESS LICENSE <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />BUSINESS LICENSE NO. 84 .( d- U�) 1 66 <br />TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br />Business Information <br />Business Name: V4 PA14 <br />Business Address. '/j0 <br />Cross St CA -_—zl <br />DBA Mailing Address: <br />City: <br />Stat : <br />ZIP: <br />Phone #: _ \ <br />Assessor Parcel Number(s),Z� <br />Email: <br />Q Q <br />Other Businesses at this Address: <br />Previous Business at Address: <br />Description of Business Operation:: <br />Type of Organization: ZSingle Owner ❑ Partnership ❑ Corporation ❑ Other: <br />Estimated Number of Full Time Employees: <br />Estimated Number of Part Time or Se sonal Employees: <br />Applicant Last Name: <br />Applicant First Name: <br />Applicant Mailing Address:Aq P <br />City <br />State <br />ZIPqS Applicant Phone No: <br />Water Supply: E715ublic ❑ On-site Well Sewage Disposal: ❑ Public Septic System <br />Will there be any sale of firearms? ❑ Yes CY Co <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/A ent' projec <br />Applicant' ure.-� <br />Date: L� <br />STAFF USE ONLY <br />G/F Designation: <br />Zoning: — <br />Use Type: r%fCA <br />DEPARTMENf <br />APPROVED DENIED <br />AI AIDAT <br />Development Services <br />Planner Name: Z— <br />r'— <br />Building Inspection <br />Environments alth Div <br />Fire WardenK - iJ <br />Public Works <br />M.H.C.S.D. <br />License Approved For: <br />Remarks: <br />Q C1,41 ! n •'o FA r r (4 Ir' <br />(? - <br />Occ. Grp. <br />Accepted as Complete: <br />Date: <br />F/ApplicationsForm s&Handouts/PlanningApplications/Business License (Revised 02-24-15) <br />Page 3 of 6 <br />