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REeEIVED <br /> APPLICATION — BUSINESS LICENSE <br /> NOV 1 9 2007 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ka-ry I { <br /> ��� �'i Community Development Dept BUSINESS LICENSE NO. <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> ,ll L Business Informatio1n3 <br /> Business Name: �1Ct 'r/G I � ✓) n dL7A- Ad L),f <br /> Business Address: 1) , L\, Cross St <br /> DBA Mailing Address: b City: StateZIP:q`,b <br /> Phone a: Assessor Parcel Number(s): a - 7D U / <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Type of Business: <br /> Type of Organization: ❑ Single Owner ❑ Partnership ❑ Corporation Other: LLL <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: n n L n Applicant First Name: <br /> Applicant Mailing Address: <br /> City ��-y State ZIP�g<,;j/ Applicant Phone No: ,s�li`cJ q 3 3CoU <br /> Water Supply. ❑Public WOn•site Well Sewage Disposal: ❑ Public 57 Septic System <br /> . Will there be any sale of firearms? ❑ Yes No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> 1,affirm,all the above information is true nd correct Date: <br /> Applicant's Signature: 1^ I 0//11/0-7 <br /> STAFF USE ONLY <br /> G/P Designation: I (_ Zoning: L Use Type: <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planne ame: —� <br /> Building Inspection <br /> Environmental Health Div o 0 <br /> Fire Warden <br /> Public Works (I+ t7 <br /> M.H.C.S.D. <br /> License Approved For: <br /> Rema rks: <br /> Occ.Grp. <br /> Accepted as Compl Date: <br /> F:\DevSvc\Planning Application Forms\Business License(Revised 09-12.07) Page 2 of 7 <br />