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.............. . <br /> Pte 053, ?-'-0 <br /> 8'- 7- a-- <br /> -- <br /> i APPLICATION — BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> „! BUSINESS LICENSE NO, <br /> 4i';u utiii�. <br /> I : <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: J. R. Simplot Company d/b/a Simplot Crower Solutions ` <br /> t � <br /> Bus fnessAddress, 4863 Carpenter Road Crossst I, <br /> DBA M211fngAddress: Box 31870 City: Stockton slate: CA zIP: 95213 f <br /> I : <br /> PhonefE: (209) 941-4628 ,f AssossorParcel Numbor(s): ` OS[) — t b <br /> Emal1: —11C <br /> i <br /> Other Businesses at thls Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: <br /> Retail Sales of agricultural products I; <br /> r � <br /> Typo of Organization: ❑ Single Owner ❑ Partnersh)p [ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: Do�S_ Applicant First Name: S —_� <br /> Applicant Mailing Address: .fl��J ~(�� �04/' 777 I <br /> City ( �3 7 Stafo TI —•Z/�� Applicant Phone No: C '�/ <br /> Water Suppfy: ❑Public n-stto Well Sawage Disposal: ❑ Public epuo System <br /> Will there be any sale of freatrns? ❑ Yes e <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS, <br /> 1,affirm,tinder penalty of perjury that all the above Information is true and correct Date: <br /> I'the Ovaier/Agent agree,to defend,)nda f€x,and hold harmless the County and Its <br /> agents,officers and employees from agry clai i,action or proceeding against the County <br /> arising from the Owner/Agent's proje . //�/� <br /> Applicant's Signature_ /J�� <br /> STAFF USE ONLY ^i ��- <br /> GIP Daslgnation: X Zoning: 1: 1r Use Type; r <br /> DEPARTMENT APPROVED DENIED D TE <br /> Development services Planner Name: 2 5y L <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> M,H,C.S.D. — <br /> Llcense Approved For. <br /> Remarks: <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F/App!lcalion sForms&Handouls/PlanningApplicatlonslBuslness license(Revised 11-14-11) <br /> Page 2 of 6 <br />