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APPLICATION — BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. <br /> •-�/F Rte\ <br /> P <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business`Information <br /> [Business Name: <br /> Business Address: rt t_ �( Cross St , t/ <br /> S, <br /> DBA Mailing Address: S r•L c City: rumoState: G� ZIP: S 37 <br /> Phone#: — 3 V — S--(,7 4rAssessor Parcel Number(s): <br /> Email: — Qi 6t <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Type of Business: h�/ �r.'� ti >L v C („✓1 W <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. � /" Applicant First Name: <br /> Applicant Mailing Address: {��_ ✓� <br /> City Iq,,—/-C/ I State6tj I ZIP f 4 I Applicant Phone No: S— <br /> Water Supply: []Public CK On-site Well Sewage Disposal: ❑ Public <br /> Septic System <br /> Will there be any sale of firearms? ❑ Yes da-No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I,affirm,all the above information is true and correct Date: Q <br /> Applicant's Signature: / /✓/) <br /> STAFF USE ONLY <br /> G/P Designation: r Zoning: Use Type: <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: . a :Z:2 <br /> Building Inspection <br /> Environmental Health Div 3 h z 1 o g <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D_ <br /> Sheriff(Junk Dealers Only) <br /> License Approved For: �� t <br /> Remarks: C _ _ 2,. <br /> SLA o0c)(01 q o Occ.Grp. <br /> Accepted as Complete Date <br /> \ QS 0LS <br /> F:\DevSvj\P1anning Application FormslBusiness License(Revised 12-24-07) Page 2 of 8 <br /> e7 VV <br />