Laserfiche WebLink
yd'-dco -1�— <br /> pp4 APPLICATION — BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOP Er DEPARTMENT <br /> P: <br /> N: <br /> I BUSINESS LICENSE NO. , <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: '�y Le- <br /> Business Address: `Q1 Y SA4Cross St <br /> DBA Mailing Address: D , City: DCkAO r1 Slate: [ot ZIP: <br /> Phone#: 205 vq,.6 I Assessor Parcel Number(s): <br /> Email: m ' <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: A Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: Applicant First Name: V " <br /> Applicant Mailing Address: 0 - W <br /> City kD UL Stale Cf! 21P Q Applicant Phone No: Z ) ,C,f _ I ( 57;i <br /> Water Supply. �!Rublic ❑ On-site Weft Sewage Disposal: 0 Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes 51 No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> 1, 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 andemployees If any claim,action or proceeding against the County <br /> arising from the Owner/Age ' p Oct.Ej <br /> IZ <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> GIP Designation: Zoning: L Use Type: Wltc& j 4teoF �1jr/L <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services planner Name. <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden eK <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For. f/W <br /> d <br /> Remarks: <br /> L- <br /> Acce ' � — 1r <br /> Occ.Grp. <br /> pted as Complete: Date: <br /> F/ApplicationsFormsBHandouts/PlanningAppliwtions/Business License(Revised 11-14-11) <br /> Page 2 of 6 <br />