Laserfiche WebLink
APPLICATION - BUSINESS LICENSE <br /> MAR 0 2 2016 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE 11140. <br /> ENVIRONMENTAL HEALTH <br /> PERMFFISERYIM <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: E v /'f iA,7 <br /> Business Address: o9 ���.. 6, Ci}g Cross St 11 <br /> DBA Mailing Address: �"� ` City- eul State. Ct ZIP:,..rS-,� <br /> Phone#: /p '76 —1/37 Assessor Parcel Number(s): <br /> Email: <br /> �l�vHO i[.�7izR� oma, c�-•ti <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: x,62 42,10 <br /> Type of Organization: Single Owner ❑ Partnership ❑ Corporation ❑ Other- <br /> Estimated <br /> therEstimated Number of Full Time Employees: tl Estimated Number of Parti a or Seasonal Employees:Q <br /> Applicant Last Name: "45 _, f A • Applicant First Name: U/ <br /> -Applicant Mailing Address: Z�J /iV 7 Iy(> GT <br /> City State- ZIP95-;5 xj Applicant-Phone No: 5/c <br /> Water Supply: ❑Public Er6n-site Well Sewage Disposal: ❑ Public •tom 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,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 Qwner/A e is projee <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> G/P Designation: 4 Zoning: Use Type: ( ,rs <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection (, <br /> Environmental Health Div � V`^ Io to <br /> Fire Warden TC <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For. <br /> Remarks: <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicationsForms&Handouts/PlanningApplications/Business License(Revised 02-2415) <br /> Page 2 of 6 <br />