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Em APPLICATION - BUSINESS LICENSE -SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT SEP 01 2015 BUSINESS LICENSE N0. I �- f I b TO BE COMPLETED THE APPLICANT PRIOR TO FILING THE APPLICATION Business Information Business Name: (, p Business Address: Cross St DBA Mailing Address: L{ IVIS �, n 5 GG(( i City: d l l I State: ZIP. it Phone #: .23 —'S 71D Assessor Parcel Number(s):- Email: t I S CLY, @ M Other Businesses at this Address. Previous Business at Address: Description of Business Operation:: Coy14ro,(-Aor Type of Organization: 0 Single Owner ❑ Partnership Corporation ❑ Other: Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: 0 -Applicant First Name: (` VI Applicant Last Name: y 0 Applicant Mailing Address: 2-14 Boso D City F re— m State 0\ Z1P Applicant Phone No: rj (� — g — t 5 Water Supply: ❑Public4On-site Well Sevrage Disposal: [I Public Septic System Will there be any sale of firearms? ❑ Yes No NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. 1, affirm, under penalty of perjury that all the above Information is true and correct I, the OwnerlAgent agree, to defend, Indemnify, and hold harmless the County and its agents, officers and employees from any claim, action or proceeding against the County arising from the Owner/Agent's project. Applicant's Slgnaturj(,- O Date: STAFF USE ONLY G/P Designation: t/ Zoning: L, Use Type: <,eN Fetvil DEPARTMENT APPROVED DENIED DATE Development Services Planner Name: Building Inspection Environmental Health Dive d (p 1 Fire Warden Public Works M.H.C.S.D. License Approved For: Remarks: v Grp. Accepted as Complete: Date: F/ApplicationsForms&HandoutslPlanningAppiications/Business License (Revised 02-24-16) Page 2 of 6