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FxUAPPLICATION — BUSINESS LICENSE <br /> a '�►-' II SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> HUN <br /> {� 14 2018 <br /> BUSINESS LICENSE NO. <br /> PERMIT i <br /> ggg <br /> ENVIRONMENTAL HEALTH <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: i p j„ 4/+C 41,LC-57- <br /> Business Address: 2L f��U (ytl(;1.�-r lUv e� ;j-Cross St ; <br /> c1 <br /> DBA Mailing Address: � wn �T��D City: `� }v,\ State:( ZIP Z,'S <br /> Phone#: L O rt� -I�I - U,fa 3 I`� Assessor Parcel Number(s): <br /> Email `', �jr- ✓k. d ,1JS ( art Gv� <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: � - l r e <br /> Type of Organization: ❑ Single Owner ❑ Partnership I .Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant last Name: Applicant Frst Name: <br /> Applicant Mailing Address: J Uv <br /> City � (' , Loi, State ZI S j U S Applicant Phone No: 2 -Y <br /> Water Supply: 41P-ubiic ❑ On-site Well Sewage Disposal: Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes j 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 <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> G/PDesignation: Zoning: — lJ UseType: (G <br /> DEPARTMENT APPROVED DENIED DATE <br /> IE <br /> Development Services Planner Name: �• (, <br /> Building Inspection <br /> Environmental Health Div 60 ( Z?2 <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For. <br /> h t ease q/-e,, i) vse s- ` p <br /> Remarks: /L' Z`1 76 Lam, +5� L' �� I?0 6�-C�f S <br /> occ.Grp. <br /> Accepted as Complete: Date: <br /> r"/ApplicationsForms&Handouts/PlanningApplications/Business License(Revised 02-24-15) <br /> Page 3 of 5 <br />