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0 <br /> • ag�'n. APPLICATION — BUSINESS LICENSE <br /> 2 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> =• BUSINESS LICENSE NO. <br /> ' P <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: j IN <br /> Business Address: Cross St <br /> DBA Mailing Address: G (_ ��US City: ( )(yo olu State: ( ZIP:O <br /> Phone#: (i(,cl Assessor Parcel Number(s): 010 ` Z <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: I ,t 1 <br /> Description of Business Operation:: !�I+�/) I L 7 �r` I C� X t�� )c <br /> Type of Organization: 0 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: A�l <br /> Applicant Mailing Address: L� , ( 6 4 C <br /> City 7�• State /'/J ZIP 7 ZC Applicant Phone No: r�•� <br /> Water Supply: ❑Public ❑ On-site Well Sewage Disposal: ❑ Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes R 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 /7/C, Z�� <br /> arising from the Owner/Agent's�prroje'ct. <br /> Applicant's Signature: .c <br /> STAFF USE ONLY <br /> G/P Designation: J (✓ Zoning: — Use Type: <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: 7() <br /> Building Inspection <br /> Environmental Health Div 5 <br /> Fire Warden 5 0 <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: ff �� ✓ - <br /> QY <br /> Remarks: sovvp <br /> - 3 Occ.Grp. <br /> Accepted as Complete: Date: <br /> F\DevSvc\Planning Application Forms\Business License(Revised 01-25-10) Page 2 of 7 <br />