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APPLICATION - BUSINESS LICENSE <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />BUSINESS LICENSE NO. <br />' TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br />Business Information <br />Business Name: N f by <br />Business Address: a L{, =n <br />•+o <br />Cross St <br />,��1�t <br />DBA Mailing Address: gZZg to fin 1 �Y 111-%}- <br />City: U StCA C t <br />State: �} <br />ZIP: yZ�� <br />Phone #: 7(40-5j$—Z3L/ <br />Assessor Parcel Number(s): <br />Email: KLk ` .R rb Cts m <br />Other Businesses at this Address: <br />Previous Business at Address: — <br />Description of Business Operation:: �-j, , <br />Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other: <br />Estimated Number of Full Time Employees: <br />Estimated Number of Part Time or Seasonal Employees: <br />Applicant Last Name:o <br />`� n <br />Applicant First Name: l� <br />Applicant Mailing Address: 9 4 y 4 ACJ k" <br />CityC"\�1�� State CA4 <br />ZIP f <br />Applicant Phone No: - 53� -- Z Z <br />Water Supply: []Public ❑ On-site Well <br />Sewage Disposal: Public ❑ Septic System <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, under penalty of perjury that all the above information is true 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 cl im, 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/PDesignation: -I /_ Zoning: <br />Use Type:('(} <br />DEPARTMENT APPROVED <br />DENIED <br />. DATE <br />Development Services r/ <br />Planner Name: <br />Building Inspection <br />/ <br />Environmental ealth Div <br />Fire Warden <br />Public Works <br />M.H.C.S.D. <br />License Approved For: <br />Remarks: <br />5 8 `' -' � � l � �' <br />Occ. Grp. <br />Accepted as Complete: <br />Date: <br />F/ApplicationsForms&Handouts/PlanningApplications/Business License (Revised 02-24-15) <br />Page 3 of 6 <br />