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Fop <br /> - oPAUIfy c — BUSINESS LICENSE <br /> a �t'•.p <br /> a' y SAN JOAQUIN COU%%GJ)F ITY DEVELOPMENT DEPARTMENT <br /> E��I� lGIE NO. <br /> a? < I &W Q�( '��zk� <br /> • <br /> �•''/F o••is�p OFRCE OF EMERGENCY SEFMCES <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> B siness Information <br /> Business Name: <br /> Business Address: 10979Hwg99 Cross St <br /> DBA Mailing Address: City: `Cot State: rA zlP:9qj5io <br /> Phone#: 70-7117-29`_5- Assessor Parcel Number(s): <br /> Email: cy A <br /> Other Businesses at this Addres . <br /> Previous Business at Address: <br /> Type of Business: h <br /> Type of Organization: Single Owner ❑ Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: Applicant First Name: N AZA <br /> Applicant Mailing Address: <br /> City State ZIP p Applicant Phone No: p �j <br /> Water Supply: []Public On-site Well sewage Disposal: ❑ Public 92SepticSystem <br /> Will there be any sale of firearms? ❑ Yes ❑ No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I,affirm,all the above information is true and correct Date: <br /> Applicant's Signature:. <br /> STAFF USE ONLY <br /> G/P Designation: Zoning: <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> Sheriff(Junk Dealers Only) <br /> License Approved For: <br /> 5 <br /> Remarks: <br /> rCCj 6 L- 0 <br /> -19;L- <br /> BL Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:\DevSvc\Planning Application Forms\Business License(Revised 03-09-09) Page 2 of 7 <br />