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oPAE r�� APPLICATION — BUSINESS LICENSE <br /> - z SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. �!_ —��l/(] �-� <br /> ----; <br /> , t <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> BusinessName: Pqlzqv 1/7p . <br /> Business Addness:ao 00 e e ;c crosast H; 'Zro e ,tilQ <br /> OBA Malling Address: 5»,,4_g coy gcAm p I State: LP: 9S3ap <br /> Phone#: a o • 3 34-1 9 cf Hawser Parcel Number(s): 01-7 - /-/0 _ va <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: 6 S . , Ni r '?,YC/ <br /> Type of Organization: e Single Owner ❑ Partnership Corporation ❑ Other <br /> Estimated Number of Full Time Employees: c/ f. Estimated Nrmber of Pan Time or Seasonal Employees: <br /> Applicant Last Name: RociApplicant First Name: r_0 <br /> Applicant Mating Address:,a o v d o e <br /> City qL4 ^D State ZIP'7Sa,,0ApplicentPhoneNo: aOcl 334 lqet <br /> Water Supply: ❑Public 9-On-site Well Sewage Disposal: ❑ Public R'Septic System <br /> Will there be any sale of Ilreanns7 ❑ Yes Q'No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> 1,affirm,under penalty of perjury that all the above information is true and correct Date: <br /> 1,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 Ow /Age rs project <br /> Applicant's Signatse: <br /> STAFF USE ONLY <br /> GfP Designation: zoning: yb Use Type: <br /> DEPARTMENT APPROVED DENIED DAT <br /> Development Services Planner Name: L / <br /> Bulldng Inspection <br /> Environmental Heath Div <br /> Fire Warden L4 id, Ji <br /> Public Woos <br /> M.H.C.S.D. <br /> License Approved For. <br /> Remarks: <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:WwSvdPlannbg Apel c dwn FohmslBu tmss Lceree(Revrsed 7-14-11) Page 2 of 8 <br />