Laserfiche WebLink
APPLICATION —BUSINESS LICENSE <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />BUSINESS LICENSE NO. �� I <br />TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br />Business Information <br />Business Name: orvO fmn <br />Business Address: �� ` <br />Cross St �ti N k, <br />DBA Mailing Address: p ® ! <br />City:���K ( State: L <br />Assessor Parcel Number(s): <br />Phone #: 7i0 1i — 1 -q4P <br />Email: B%ttlylAnA, pattmaa <br />Other Businesses at this Address: (� <br />Previous Business at Address: <br />c <br />Description of Business Operation:: <br />Type of Organization: -0 -Single Owner ❑ Partnership ❑ Corporation ❑ Other. <br />Estimated Number of Full Time Employees: 19- <br />Estimated Number of art Ti _eor Seasonal Employees: <br />Applicant Last Name: S L" ' <br />Applicant First Name: Mar(�. <br />Applicant Mailing Address: U <br />City <�t <br />State <br />ZIP 1 c"j ) <br />Applicant Phone No: ie <br />Water Supply: []Public ❑ On-site Well <br />Sewage Disposal: ❑ Public ❑ Septic System <br />Will there be any sale of firearms? ❑ Yes U=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 :rue 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 />Applicant's Signature: <br />Date: <br />STAFF USE ONLY <br />G/P Designation: <br />Zoning: (— <br />Use Type: •- ; �� ` C}�i �)(�I v) �IU� <br />DEPARTMEN <br />APPROVED <br />DENIED <br />DATE <br />Development Services <br />Planner Name: <br />Cj S <br />Building Inspection <br />Environmental Health Div <br />Fire Warden <br />Public Works <br />Erb T,,'QNMEN rTC <br />M.H.C.S.D. <br />License Approved For: �� j �_. �I Gt I vGN 4'11' Il 1 Yi iC � CPT <br />EM 111'1 ti,I.Wvj lav,o &Lve iv <br />4' (W A. <br />Remarks: / I <br />Occ. Grp. <br />Accepted as Complete: <br />Date: <br />F/ApplicationsForms&Handouts/PlanningApplications/Business License (Revised 02-2415) <br />Page 3 of 6 <br />