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oP4 ''n..F APPLICATION `-BUSINESS LICENSE <br /> q <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. lJ 1 0 - ` S <br /> FO <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> B siness Information <br /> Business Name: S I'7,( L O r .5 <br /> Business Addre. f I r1G Cross St - <br /> DBA Mailing Address: `p City: State: ZIP: <br /> Phone#: ;L-6 Y6& — Assessor Parcel Number(s): I <br /> Email: -y 0 r nek <br /> Other Businesses at this Address. <br /> Previous Business at Address: <br /> Type of Business: <br /> r-0. Ql <br /> NT- <br /> Type <br /> Q ( I✓I <br /> Type of Organization: Ingle Owner ❑ P rtnership ❑ Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: 7A...� Applicant First Name: QrCe_I 10 0 <br /> Applicant Mailing Address: Q box 153 <br /> Ciry State ZIP Applicant Phone NT-3 5�,- aI <br /> Water Supply: []Public p—On-site Well Sewage Disposal: LKPublic ❑ 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,all the above infonmatio is true and correc Date: <br /> Applicant's Signature'.^ i Yf�-- v , O <br /> STA SE ONLY ) c, <br /> GIP Destgnabon: Zoning: / Use Type: <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: ,o <br /> Building Inspection <br /> Environmental Health Div O <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> Sheriff(Junk Dealers Only) <br /> License Approved For: a- -�}- <br /> d L/ <br /> Remarks: ,_ ti- <br /> oU <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:tDevSvclPlanning Application Forms\Business License(Revised 05-01-08) Page 2 of 7 <br />