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ip APPLICATION — BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> , -' n �^ <br /> BUSINESS LICENSE NO. k1 J "," <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATI ' <br /> Business Information `AN'10"ail.`, '4 T',' <br /> Business Name: / H`9A!XH❑E: r1T <br /> Business Address: L,70 N, Cross St <br /> DBA Melling Addres .86k'.:L6(O'4 �y city: stauO le:Glq, zlP: 2-24 <br /> Phone#: Assessor Parcel Number(sl: \LAO - —`R . <br /> Email: S 773 AOL— , COQ <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: <br /> Type of Organization: Single Owner ❑ Partnership ❑ Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: Estimated Number of Pan Time or Seasonal Employees: 2— <br /> Applicant Last Name: /25� s' Applicant First Name: .e <br /> Applicant Mailing Address: -20 yp p V 4—(W7,e oC , <br /> Ciry � ) t7 State ZIP Zy,, Applicant Phone No: 33 <br /> Water Supply: []Public On-site Well Sewage Disposal: ❑ Public Septic System <br /> Will there be any sale of firearms? ❑ Yes IN 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,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/Ag t s pr set.. . <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> GIP Designation: Zoning -LAO , Use Type: <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div l� <br /> Fire Warden GI, fit" <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved Far. U <br /> Remarks: <br /> '1 DCC.Grp. <br /> Accepted as Complete: Date: <br /> F:Vev$vc%nanning Application Forms\Business License(Revised 01-25-10) Page 2 of 7 <br />