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oPnul!y c <br />r .•c.A <br />gL•iuu•e't>� <br />APPLICATION - BUSINESS LICENSE <br />SAN JOAQU7N COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />BUSINESS LICENSE NO. �4,` 1 S JJ l S � <br />TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br />Business Information <br />Business Name: Loocz. <br />oL O � e. <br />Business Address: Nlkoo 6- <br />r Cross St Y I <br />DBA Mailing Address: Ai <br />City: !' -�.� <br />State: <br />ZIP: <br />Phone #: C1 —IR -5r <br />Assessor Parcel Number(s): Gl ! <br />Email: l Q �� � Mn <br />Other Businesses at this Address:]RECEIVED <br />Previous Business at Address: <br />Description of Business Operation:: —"- Cil 111 N 0 4 '?Ti3 <br />ENVIRONNIENTAL' <br />.1. <br />Type of Organization: $ Single Owner <br />❑ Partnership ❑ Corporation ❑ Other. <br />Estimated Number of Full Time Employees:Estimated <br />Number of Part Time or Seasonal Employees: <br />Applicant Last Name: <br />Applicant First Name: <br />Applicant Mailing Address: <br />CL f<- <br />City 3 <br />State <br />ZIPq5W <br />Applicant Phone No: C;�o cl ) 6 *A q _ 3 2. <br />Water Supply: ❑Public On-site Well <br />Sewage Disposal: ❑ Public j Septic System <br />Will there be any sale of firearms? ❑ Yes )V No <br />NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br />1, 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: ,r <br />Date: <br />_ _ <br />STAFF USE ONLY <br />G/P Designation: ` Zoning: <br />Use Type: <br />DEPARTMENT APPROVED <br />DENIED <br />DATE <br />Development Services <br />Planner Name: <br />Building Inspection <br />Environmental Health Div <br />Yt�t U <br />Fire Warden <br />Public Works <br />M.H.C.S.D. <br />License Approved For: ��„ ,i �� i c e ;ti F-9 <br />Remarks: L)-6 .' o J <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 />