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APPLICATION - BUSINESS LICENSE SAN JOAOUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT 4. BUSINESS LICENSE NO. .I�I,KpN1j. TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION Business Information Business Name. O Business AddressCross StQqFts DBA Mailing Address: • Lie Ir �, #A25 City: �'rClhO ! 4 Slate CA ZIP' D Phone#- ty) Assessor Parcel Number(s). 1-79. 1-11 . 13 Email. t Other Businesses at this Adores Previous Business at Address: Descnption of Business Operation N einiq - P.r-�s Type of Organization: ❑ Single Owner ❑ Partnership A Corporation ❑ Other: Estimated Number of Full Time Employees 3 stimated Number of Part Time or Seasonal Employees: Applicant Last NameApplicant First Name'. Applicant Mailing Address: State� n O e,Q7 ' City ,bi Z O 1 Applicant Phone No: 9l b 50 - '-I5qLI Water Supply []Public QQ On-site Well Sewage Disposal: IX Public ❑ Sepbc System Will there be any sale of firearms? ❑ Yes A No NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. 1,affirm, under penalty of perjury that all the above information Is true and correct Date: I,the Owner/Agent agree, to defend, indemnify,and hold harmless the County and its agents,officers and employees from an claim,action or proceeding against the County arising from the Owner/Agent's pr Applicant's Signature: STAFF USE ONLY GIP Designation: L Zoning. - Ll Use Type: SC• 4 DEPARTMENT APPROVED DENIED DATE Development Services Planner Name: 1 L Budding Inspection Environmental Health Div 4 4 Fire Warde tZ[ flL Public Works M.H.C.S.D. License Approved For a ' ' `(f /Wv- LW /U,�, /f9 O�G Remarks: Occ.Grp. Accepted as Complete. Date: F-\DevSvcV'anning Application F000s\Busim"Ul nse(Revise 01-25-101 Page 2 of 7