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••.p AVR 2 2 2014 APPLICATION — BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ENVIRONMENTAL HEALTH BUSINESS LICENSE NO. ( , j <br /> PERMIT/SERVICESIrV <br /> •rt•rku'd� <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: SY\\'{��^(\\Ck S'�� .�\ 0, \V\ �{ <br /> Business Address: 5j Crass St i 1" {y t t <br /> I DEA Maillrig Adllrpss. - Cdy:� Slate: l ZIP:aT, �Qtjj <br /> Phone# Q bo•(moo Assessor Parcel Numbsr(s): <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: <br /> Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: (\D Estimated Number of Part Time or Sea nal Employees: d <br /> "APRI1r f+(,�at N?me:,;_:. •�' Y bppIII ani Irpt Name,;:,` ON a <br /> \ <br /> Applicant Mailing Address: <br /> to \t a VIM <br /> CitylT ( State A ZIP Applicant Phone No: <br /> Water Supply. ❑Public On-site Well Sewage Disposal: ❑ Public JerSeptle System <br /> Will there be any sale of firearms? ❑ Yes X 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 Dale:QL, Cl{ \'l <br /> I,the Owner/Agent agree,to of nd, Indemnify,and hold harmless the County and Its <br /> agents,officers and empl ee from any claim,action or proceeding against the County <br /> arising from the Owner/ en ' project. <br /> 4 <br /> Applicant's Signature: FOR SHIM WICK CONST,CO.,INC. <br /> STAFF USE ONLY <br /> GIP Designation: Zoning: Use Type: G r <br /> DEPARTMENT APPROVED DENIED DTE <br /> Development SeMoes Planner Name: <br /> Building Inspection <br /> Environmental Health Div "` <br /> Fire Warden f T <br /> Public Works <br /> M.H.G.S.D. <br /> License Approved For. s1tyV <br /> V <br /> Remarks. .� /�W'CJZPss <br /> Occ.Grp. I. <br /> Accepted as Complete: Date: <br /> F/ApplicallonsForms&Handouts/PlanningAppllmgons/Buslness License(Revised 11-14-11) <br /> Page 2 of 6 <br />