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q�IN APPLICATION — BUSINESS LICENSE <br /> '•' �` Aa SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. VA-Y1 0 !' <br /> CiFoae' <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATi. <br /> Business InZPame[Number(s): <br /> Business Name: &r-.e1A,H yr <br /> Business Address: 3d3p 5, 1.�ttle w0. q7 Cross <br /> DBA Mailing Address: 0231 80W%W\ $f Qty: State: G} ZIP:Q �p�- <br /> Phone;--(—a O (v 1c Asses <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: (-&v\p C Ci- <br /> Type of Organization: ❑ Single Owner ❑ Partnership 14 Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: .2 Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: ogaoM Applicant First Name: �Q„ C- <br /> Applicant Mailing Address: 231 Sowr <br /> City 51 State ZIP uj - Applicant Phone No: - <br /> Water Supply: ❑Public J6 On-site Well Sewage Disposal: ❑ Public Co Septic System <br /> Will there be any sale of firearms? ❑ Yes Od 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 true and correct Date: <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 /> STAFF USE ONLY <br /> G/P Designation: 1/ ZoningUse Type: G I11r <br /> DEPARTMENT APPRD DENIED ATE <br /> OVE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warde '(- <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: <br /> Remarks: <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:\DevSvc%Planning Application Forrns\Business License(Revised 01-25-10) Page 2 of 7 <br />