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APPLICATION — BUSINESS LICENSE <br /> {-�f'• i SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> C <br /> ' BUSINESS LICENSE NO. r �C70� <br /> TO'BE.COMPLETED BY THE APPLICANT PRIOR.TO FILIN6:THE APPLICATION <br /> Business Information <br /> Business Name: L-(+ G�}GtSS($ `� oyvt-c 1 N-w Pwa 'r L-( -C <br /> Business Address: Cross St C to <br /> DBA Mailing Address: Z(� ��N S�' City: Cay�rn1`wvr/ Stater ZIP:crc�s(� <br /> Phone#: �rj Zb Assessor Parcel Number(s): Cl 2 <br /> Email: j Gc�'l v�ZdU at 1�drJ^ C �l -y <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation;: <br /> t ur ✓S -1v s V - <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: TS l—d <br /> Applicant Mailing Address: Z( 7 N/-� §-1 <br /> City�j �tf wvU State C,1� I ZIP 13 Applicant Phone No: ZS SS- VZC- <br /> Water Supply: ❑Public E4-On-site Well Sewage Disposal: ❑ Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes 0-filo- <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. <br /> Applicant's Si nature: <br /> STAFF WE ONLY <br /> G/P Designation: ` L Zoning: ,"L Use Type: <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Na e: Nt MCI$ <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden f-c'm Z <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For. Q ( <br /> Remarks: <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicationsForms&Handouts/PlanningApplications/Business License(Revised 11-14-11) <br /> Page 2 of 6 <br />