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RECENED <br /> °` •. FEB 5 2013 APPLICATION — BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> N: ' e <br /> ENV =ONMENTrRLNEALT- BUSINESS LICENSE NOL'I?,UCX7? <br /> � <br /> PERMITISERVICES <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO HL[NC'THI= QPPUCATION' <br /> Business Information <br /> Business Name: n t) SI r ,v L• 0 0A 01 -clew,P v <br /> Business Address; I jig OS- Q Cross$t NW t <br /> DBA Mailing Address: lrld City:1 F'G'4"A State: A— ZIP: a,,j 2-J-2 <br /> Phone*., C1 r -,Z.,Q 7 Assessor Parcel Number(s)•_(js.! <br /> Email:AU tG Ivt'i , <br /> Other Businesses at this Address: /Uo,)e_ <br /> Previous Business at Address: <br /> Description of Business Operation;: S F��tldtr 1,4`�—d1^ <br /> Type.of Organization; 0 Single Ovmer 0 Partnership (&Corporation 0 Other. <br /> Estimated Number of Full Time Employees: C) - Estimated Number of Part Time or Seasonal Employees: . <br /> '.. Applicant Last Name: Vtw l Applicant First NNrs <br /> Applicant Mailing Address: ,04 U I/0 r) �-OGu.Z, <br /> City L-d G State ZIP Applican Phone No: dW--.7yS'1.��`✓7 <br /> Water supply: CPUblic Ko— Well Sewage Disposal: 0 Public I\sepuc system <br /> Wlllthereboany sale ofilroanns2 D Yes 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 /> 1,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 Owner/Age is project. <br /> Applicant's Signature: <br /> STAFF USE ONLY L <br /> GIP Designation: ' Zoning; I.-L Use Type; ly l� — LCL <br /> DEPARTMENT APPROVED DENIED I1TE <br /> Development Services; Planner Name: I r <br /> Buliding-11110 11on C—-- <br /> EnvironmentalHealth Div <br /> Fire Warden 0 <br /> Public Works <br /> M.H.C.S.D. _�- <br /> License Approved For. <br /> Remarks: <br /> Occ,Grp, <br /> Accepted as Complete: Dale: <br /> F/ApplicallonsFormsBHandoutslPlanningApplicatbns/Business License(Revised 11-14-11) <br /> Page 2 of 6 <br />