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tom•.. 'APPLICATION - BUSINESS LICENSE <br /> r SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> r <br /> BUSINESS LICENSE NO. 6I' <br /> • u_ va` <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: a x � <br /> Business Address: S{- Cross St <br /> DBA Mailing Address: _� City: - - State: fcl ZIP: ' c. <br /> Phone# — 5 Assessor Parcel Number(s): — 1 <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: . cc\r <br /> Description of Business Operation:: a <br /> Type of Organization: ❑ Single Owner Partnership ❑ Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: I Estimated Number of Pad Time or Seasonal Employees: <br /> Applicant Last Name: ' ✓Y'L Applicant First Name: R 7 <br /> Applicant Mauling Address: I'v\o ej r e e 1 ,/' <br /> ,/-A�t. <br /> City 6Y1 T State CPI. I ZIPys Applicant Phone No:(2,0S/ — j <br /> Water Supply: ❑Public ❑ On-site Well Sewage Disposal: [1`0ublic ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes QINo <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 Date: 11- <br /> 1, <br /> I—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 y� y <br /> Applicant's Signature: I t jX Q I C(/,"j f �L G <br /> STAFF USE ONLY <br /> G/P Designation: T� Zoning: Use Type:Iw; • lv,, llf <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name. - II Ila("Al I <br /> Building Inspection <br /> Environmental Health Div <br /> Fre Warden <br /> Public Works <br /> M.H.C.S.D. " <br /> License Approved For. r�l.L ^e �' c t`J ur, <br /> JP <br /> Rdmarks 11 C'0 0C 12019- V4- 00-3 -1 <br /> ON - 1 c) b D <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicabonsForms&HandoutslPlanning4plicabons/Business License(Revised 02-2415) <br /> Page 3 of 7 <br />