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-- <br /> �. APPLICATION-c- BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> I <br /> AM 1 1) 2015" BUSINESS LICENSE NO. r?L" ISVU�I� <br /> a <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATIONy� <br /> Business Information <br /> Business Name: T 0 �C�t� ce G4C <br /> Business Address: ]� SQL_\QC,� Cross St <br /> DBA Mailing Address: �qCity: G Stale: ZIP:qS7 it <br /> Phone#: 0 ! '�(� — Assessor Parcel Number(s): 750 <br /> Email: eA <br /> ;Applicant <br /> sinesses at this Address: <br /> Business at Address: <br /> n of Business Operation: <br /> rganization: Single Owner ❑ Partnership ❑ Corporation ❑ Other: <br /> Number of Full Time Employees: _ Estimated Number of Part Time or Seasonal Employees: t ? <br /> Last Name: -i-0fApplicant First Name:Mailing Address: 2 <br /> City State 71P�� (� Applicant Phone No:. eA 9. <br /> Water Supply: OPublic On-site Well Sewage Disposal: L3 Public [�Septic System <br /> Will there be any sale of firearms? E] Yes- 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 from any claim, action or proceeding against the County <br /> arising from the Owner/Agent's project. JJ <br /> Applicant's Signature: (Q <br /> STAFF USE ONLY <br /> G/P Designation: Zoning: ___1Use Type: t!0A,U6� <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services — Planner Name: IL��Q Off' ip1`ao I <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden j <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: G1/N� Y(i u�j Q V _ <br /> Remarks: <br /> Occ.Grp, <br /> Accepted as Complete: Date; <br /> F/ApplicationsForms&Handouts/Plann!ngApplications/Business License(Revised 02-24-15) <br /> Page 2 of 6 <br />