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b <br /> A �7 APPLICATION — BUSINESS LICENSE <br /> :.�► •. <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> - <br /> t. <br /> BUSINESS LICENSE NO )0 '\)071 <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: M C o,f Tipe_ n i x <br /> Business Address: 'a 6 g S, 1-7/ 60444/0ross St 671 00 a e W S <br /> DBA Mailing Address: 54okeA QS a 121, V e City: ,h State ZIP9S,23 <br /> Phone#. Q li 9 g PL -/3 a q Assessor Parcel Number(s). J 1.3 —/ 70 —30 <br /> Email Ih2rU c an � <br /> Other Businesses at this Address 0 <br /> Previous Business at Address: Cl Me <br /> Description of Business Operation:: c2 , <br /> Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other: <br /> Estimated Number of Full Time Employees. Estimated Number of Part Time or Seasonal Employees. <br /> Applicant Last Name: 1.5Lt 5� Applicant First Name: (1 ' Ael P/C <br /> Applicant Mailing Address: �j d— <br /> City State C4 I ZIP 9 �31Applicant Phone No. <br /> Water Supply: ❑Public On-site Well Sewage Disposal: ❑ Public Septic System <br /> Will there be any sale of firearms? ❑ Yes 10 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 [� oZ <br /> I,the Owner/Agent agree,to defend,Indemnity,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 Owner! ent's project�tl�k� <br /> Applicant's Signature. <br /> STAFF USE ONLY <br /> GIP Designation. Zoning, _ Use Typ <br /> DEPARTMENT APPROVED DENIED _)A E !/ <br /> Development Services Planner Name I <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: i � 1t <br /> Remarks .� <br /> Ocr. Grp <br /> Accepted as Complete Date <br /> F 0evSvclPlanning Application Forms\Business License(Revised 01-25-10) Page 2 of 7 <br />