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APPLICATION - BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> Q• t .a <br /> BUSINESS LICENSE NO. <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: W <br /> Business Address: j 10r Cross St tt <br /> DBA Mailing Address: I 17 3uo I orc h City:Tr-C, State: ZIP:Cl <br /> Phone#: c-1 - `3 C _ Lf Assessor ParcelNumber(sl <br /> Email: rtCOYA <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: cL i 4-1 vn h ouu ,t n Dixot 1-6 e <br /> rU n r7ey E <br /> ok ac r +- <br /> Type of Organization: ❑ Single Owner ❑ Partnership ❑ Corporation ® Other: ct.0_Ces5p boo <br /> I1� <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: Sc lC <br /> Applicant Last Name: CX-V\C5 Applicant First Name: a t i <br /> Applicant Mailing Address: -1 -Tr-QL y 0& G S 3 U <br /> City s r-- State CC. 1 ZIP ,4 Applicant Phone No: (;) � - - q <br /> Water Supply: ®Public ❑ On-site Well Sewage Disposal: ❑ Public EP Septic System <br /> Will there be any sale of firearms? ❑ Yes ­9�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 5 <br /> arising from the Owner/Agent's project. <br /> Applicant's Signature: IL <br /> STAFF USE ONLY p <br /> G/P Designation: Zoning: - L, Use Type: /TG 4�.) us c, Cr/��'►s' I'y"�� NP�[' <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection 5 <br /> Environmental Health Div <br /> Fire Ward <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: e �, , 9! /b�y1 •u.��-: 1 h o,��. <br /> �[`I, , ��c e �'- 1.>D Il l°e.��►�, j*e �,nJee—/0!4- <br /> Remarks: - 0 H- 1 Q m - t T <br /> Occ.Grp. <br /> 11 Accepted as Complete: Date: <br /> F/ApplicationsForms&Handouts/PlanningAp lications/Business License(Revised 02-2415) <br /> Page 3 of 6 <br />