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_ _ <br />ECF -I V E APPLICATION — BUSINESS LICENSE <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />MAR 3 1 2016 -- <br />., BUSINESS LICENSE NO. <br />�.'. •........ ,, HEALTH <br />PrpurTIRFR ACES <br />TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br />Business Information <br />Business Name: S g p o c- 1 V E C Y CLF -S <br />_ <br />Business Address: CrossSt <br />DBA Mailing Address: 7 q 3 j. I - 5T, City: ifc.A 01 State: ( ZIP: ?J-3 0y <br />Phone #: 2,<)C)- t33-J,-2?/L/ Assessor Parcel Number(s): <br />Email: S*"4J0TJ✓i.GYCA,&:5 © iA Jt .o . Cdf-I <br />Other Businesses at this Address: 4�' -- <br />Previous Business at Address: rj a rt GY CLQ 571 oP <br />Description of Business Operation:: S2 <br />Etf! c4- r �i�-1n <br />i� -- i <br />I' <br />Type of Organization: X Single Owner (_] Partnership ❑ Corporation [] Other. <br />Esiimated Number of Full Time Employees: <br />Estimated Number of Part Time or Seasonal Employees: <br />Ii Applicant Last Name: Cq--N AL,.Fp <br />Applicant First Name: � 1=NNI s <br />Applicant 7viailing Address: P. u. r3 ra <br />' 'y tate C* ZIP qS33 (o <br />Applicant Phone No: Z O ci _ (y 9 0 -Dy�-1 <br />l+ fouterSgply: [}i ublic ; On-site Well <br />Sewage Disposal: ❑ Public Septic System � <br />I! 4Viii Itiore be any sale of firearms? ❑ Yes X No <br />N07E: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERNfiT5.__.__...-._._...__ <br />I, affirm, under penalty of perjury that all the above information is true and correct <br />Date: <br />I 1, the Owner/Agent agree, to defend, indemnify, and hold harmless the Couniy and its <br />' agents, officers and employees from any claim, action or proceeding against the County <br />` <br />arising from the Owner/Ag 's project. <br />(I <br />Appilcant's Signature: - -` �y-- -- <br />— ----- - -- <br />11 L STAFF USE ONLY <br />GIP DesignaWn: Zoning: Use Type: r, _ I <br />DEPARTMENT APP VED — DENIED - DATE. -� <br />Development Services Planner Name: <br />Building Insp ection <br />i Env ironmentalHeathDiv V--- (V V� LA -5T r <br />Fire Warden- <br />—�--------• <br />-• �, <br />f'ublicVVorks <br />PA. H.C.S_D -- <br />— --------- -� -- -- - -- - -I� <br />I <br />Licens=e Approved Fordl <br />-- <br />Remarks. 1�� /r�' r/J / ,�1,' r <br />--- --.-. __---_•I <br />Occ. Grp. }{� <br />Accopted as Corlpieto: to - — -- - <br />F/AppiicadonsFoms&Handouts/PlanningApplicationslBusiness License (Revised 02-24-15) <br />Page 2 of 6 <br />