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C- ) <br /> APPLICATION - BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. C�— 1700 ZR f <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: L,p <br /> Business Address: � 6•g..- <br /> DBA Mailing Address: Y. city." State: <br /> Phoned: - J_831-00s.6 Assessor Forest N ber(s): i - p <br /> Email: ¢nAILP <br /> Other Businesses at this Address: �. 4 <br /> Previous Business at Address: 7N,i t i t c <br /> Descdpllon of Buslness Operation:: (n: l r1A ,,, eL 1 r 4 r u 1 Mz14 u c A-v <br /> Type of Organization: ❑ Single Owner Is Parorerehip ❑ Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Ti� <br /> Applicant Last Name: / 00.1 Applicant Mrst Name: WtL414M <br /> Applicant Melting Address:'6Uo E I oGy GA T3 <br /> city /Lt' stale C.A ZIP AppllceMPhweNo: ?oi- el61—ooZr. <br /> Water Supply: DIPublic ❑ On-alta Well Sewage Disposal: M Public ❑ Septic System <br /> WIN there be any safe of firearms? ❑ Yee 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 <br /> arising from the OwnerlAgent's project <br /> Applicant's Signature: 01 d <br /> STAFF USE ONLY <br /> GIP Designation: Zoning: Use Type: /- 5q I ,2i- <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: � r ?C•I <br /> Building Inspection <br /> Environmental Heafth Div L✓ - 5 / j <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved Far. ->,k y , L'.n 5 /^n" (n }/' ,E �`•L.'/• zf- <br /> Remarks: LLI OC 0 7 1 <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> FlApplicaeansFonnsaHandouts/ManningAPpfic OmeMusiness License(Revised 02-24-15) <br /> Page 2 of 6 <br />