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O'~ APPLICATION - BUSINESS LICENSE <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENTT,, <br />BUSINESS LICENSE NO.� CC�'�IZJ <br />TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br />Business Information <br />Business Name: �, I'+\;� (+ 1j�- I,r�l C (` 't ()/-1 N y <br />Business Address: . (lii t , r� t 1 l L 1� �:f.i.) L I. <br />DBA Mailing Address: i i ^, :�i"�,'vv :n L = h City: ' i; j j 1v State: P ZIP: i <br />Phone #: I l Lt- i,-' l `: - 1 `a l Assessor Parcel Number(s) i �j - 'L�� <br />Email: f L '" , 1. )f 1,k-(` t^ <br />Other Businesses at this Address: �`.1^�{, <br />Previous Business at Address: + 1l °7 ll �1`?L coil"�� •j�, ( _� <br />Description of Business Operation:: <br />Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other: <br />Estimated Number of Full Time Employees: G Estimated Number of Part Time or Seasonal Employees: r <br />Applicant Last Name: (`I j i-�L,(__ , Applicant First Name: <br />Applicant Mailing Address: v <br />\ i r ; _ Slate �' .- _ <br />City (: ,L,+ ('V t .. Vim' % zip Z, Applicant Phone No: <br />Water Supply: Public ❑ On-site Well 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 claim, action or proceeding against the County <br />arising from the Owner/Agent's project. <br />Applicant's Signature: j J• ..y.rL! <br />% ✓C�f� <br />Date: <br />13 -� �,- <br />STAFF USE ONLY <br />GIP Designation: y l Zoning: l� Use Type: <br />DEPARTMENT APPROVED DENIED DATE <br />Development Services ✓ Plann( ;I- - r� - <br />Building Inspection <br />Environmental Health Div V OyVn 51,k++- <br />Fire Warden <br />Public Works <br />M.H.C.S.D. <br />License Approved For: A � S'�� l � c'�i S�ICiC���ev�� ����� �4}LCi1 .t C_ �✓��: <br />, \�L W- <br />.lnc ( ' f'L" ' ti .1 \o--) <br />PA -0 & oo Zit co . F5L -'Q 00.;�10 <br />Occ. Grp. <br />Accepted as Complete: Date: <br />F/ApplicationsForms&Handouts/PlanningApplications/Business License (Revised 02-24-15) <br />Page 2 of 6 <br />VED <br />MC <br />JLfWN_TH <br />%1WI CI E' <br />