Laserfiche WebLink
/If)MM"1 052-ogq` <br /> e ' ~ APPLICATION — BUSINESS LICENSE <br /> ,(:• ��t S 1 X01 JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> �NVIFtONMrNFFI4.MEldLTH BUSINESS LICENSE NO. <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name:Al <br /> UI .7Y1L AY,6o <br /> l <br /> Business Address: CA 6 1y Cross Sl - <br /> DBA Mailing Address: City: Loo `V V Sate: eA I z1P: 952. qq <br /> Phone S: raag)3(t& — Ll I lAssessor Parcel Number(s): <br /> Emall: 1`�i7 14i>� 4-tY 4 A4C.JAY"dll,,'t< <br /> Other Businesses at this Address: Min <br /> Previous Business at Address: <br /> Description,of Business Operation:: 6--41,5 S G $ PC <br /> Type of Organization: 0 Single(Avner [-J Partnership Corporation r] Other, <br /> Estimated Number of Full Time Employees: Estimsled Number of Pan Time or Seasonal Employees; 1 <br /> Applicant Last Name: (14t�11�G 1•(.(�/_ _ Applicant First Name: ��u,V t Y` <br /> Applicaan"t Mailing Address: <br /> City ,xy,('IAkURlt-1p Slate CA Lp Cf542 Applicant Phone No: ( 9((p) 1151y 144 <br /> Water Supply: LIPublic ❑ On-acts Well Sewage Disposal:^0 Public Cl Septic System <br /> r1, <br /> ll there be any sale of firearms? ❑ Yes- No <br /> TE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> afFlrm, under penalty of perjury that all the above Information Is true and eorroct Date: <br /> 1,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 /> GIP Designation: C S Zoning: Use Type: 6w50 <br /> DEPARTMENT APPROVED DENIED DAT <br /> Development Services 1,/ Planner Name: <br /> Building mapecuon _ <br /> Environmental Health Div S f(J <br /> Fire Warden W o WWII <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: ! / <br /> _Ci aS ,r TAT/UM <br /> Remarks: <br /> Z Oca.Grp. <br /> Accepted as Complete: Dale: <br /> F/ApplicatlonsFormsBHandouts/PlanningApplications/Business License(Revised 11-74.11) <br /> Page 2 of B <br />