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p. .. APPLICATION - BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> PW <br /> BUSINESS LICENSE NO. — rO O 2 S— — <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> `Business Name: lwc <br /> Business Address: 3 S."9 Cross St 5• . C) <br /> DBA Mailing Address: 5�yv. Z City Tf State: t-A ZIP: Al <br /> Phone N- ���j Assessor Pa <br /> Email: <br /> Other Businesses at this Address: tv Qlaz� <br /> Previous Business at Address: <br /> Description of Business Operation.: <br /> Tvpe of Organization: ❑ Single O.vner Partnership 0 Corporation ❑ Other. <br /> Estimated Number of Full Tune Employees: 19L Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: Applicant Fist Name:•\� <br /> --Applicant Mailing Address: '(J "- <br /> Gy ___ _ StateC45, I UPgr, Applicant-Phone No: -$ <br /> Water Supply EXPubiic ❑ On-site Well Sevvage Disposal: Ik Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes 1®,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 fr any claim, action or proceeding against the County <br /> arising from the Owner/Agent's roiect. <br /> Applicants Signature I <br /> STAFF USE ONLY <br /> GP Designation: Zoning: C - Use Type: [w S es '4Stwic t - y ♦ / ppv <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services t,/ Planner Name: /f— /s— <br /> Building Inspection <br /> VL— <br /> Environmental Health Div (r( -It-t <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For <br /> tw U O � C1r <br /> Remarks: <br /> t c e �l>U Occ.Grp. <br /> Accepted a Complete: Date: <br /> F/Appl"bonsFonns&HandoLiMfPtanningApplication&Business License(Revised 02-2415) <br /> Page 2 of 6 <br />