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APPLICATION - BUSINESS LICENSE SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT '•� • BUSINESS LICENSE NO. .Q CiF�gR � TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION Business Information Business Name: 2L)q Cojaif 7ff / Business Address: 3120 . 0 1 Son Cross St DBA Mailing Address: 20 City:S4ck4oir-► State: CA ZIP: '2()C Phone#: 209- 6'70_ 9 f Assessor Parcel Number(s): Email: hour. T} I • C4)1.1 Other Businesses at this dress: /-Jo n p Previous Business at Address: 2>N(3 A b-4 Description of Business Operation:: �`�( Type of Organization: ,Single Owner ❑ Partnership ❑ Corporation ❑ Other: Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: Applicant Last Name: KauApplicant First Name: °1� Applicant Mailing Address: 20 R0Ar\ -- City SknoC -ttw\ . State ZIP �Fj21 Z Applicant Phone No- 2.0q- 90-y383 Water Supply: 01-111pubfic ❑ On-site Well Sewage Disposal: Public ❑ Septic System Will there be any sale of firearms? ❑ Yes No NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS- 1,affirm,under penalty of perjury that all the above information is true and correct Date: 1,the Owner/Agent agree,to defend,indemnify,and hold harmless the County and its agents,officers and employees from any claim,action or proceeding against the County L� arising from the Owner/A .ots pr 'ect. Applicant's Signature: STAFF USE ONLY GIP Designation: Zoning: - Use Type: S ✓' fi[,AA+ DEPARTMENT �A P OVED _ DENIED _ DATE Development Services Planner Name: Building Inspection Environmental Health Div,: Fire Warden Public Works M.H.C.S.D. License Approved For: 1WO I N d.Lb Remarks: Om Grp. Accepted as Complete: Date: F.10evSvcNP1anning ftp plication FormstBusiness License(Revised 01-2:-10) Page 2 of 7 ttcel i k s�z f �, a c -f -) '7 r f�I(I (f e-, i .� `j.`mac.