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-7 <br /> °`�aUlrJ\ APPLICATIC. _ BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. 6Z- / 2- 0 (o 17- S <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE,APPLICATION <br /> Business Information <br /> Business Name: <br /> ��l . p -a <br /> Business Address: U (36)'-) C lt. <br /> DBA Mailing Address: City: ' Stale: CA ZIP. ✓� <br /> Phone#: II / Assessor Parcel Number(s): C1 - 5/ <br /> Email: �; 1� .0 Lam /1( 1� 1 lI (V 'CiJ�r'7 <br /> Other Businesses at this Address: 1 1 <br /> Previous Business at Address: 2 0 1 C� 54-- Yv� r( )S V u <br /> Description of Business Operation:: <br /> Type of Organization: SingleOwner ❑ Partnership ❑ Corporation ❑ Olher: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees.- <br /> Applicant <br /> mployees:Applicant Last Name: r A li <br /> pp cant First Name: Art r Cf_i`Z <br /> Applicant Mailing Address: V` —T6,1,-1 J.L./ <br /> City �(/U1 State (-/4 1 ZIP Ct C' ()Applicant Phone No: ZU Z t j <br /> [Applicant's <br /> r Supply: blit ❑ On-site Well Sewage Disposal: �blic ❑ Septic System <br /> ere be any sale of firearms? ❑ Yes <br /> : ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> rm, under penalty of perjury that all the above information is true and correct Date: <br /> Owner/Agent agree, to defend,indemnify, and hold harmless the County and its <br /> ts,officers and employees from any claim,action or proceeding against the County <br /> g from the Owner/Agent's project. <br /> i I <br /> Signature: ��� G <br /> STAFF USE ONLY <br /> G/P Designation: C 6- Zoning: — �T Use Type:/7140 S-6105 � 1-cl-/I<e — /�a�d r! a��Jr 1► <br /> DEPARTMENT APPR VED DENIED DATE <br /> Development Services Planner Name: G 6 4 z <br /> Building Inspection <br /> Environmental Health DivV <br /> q i i <br /> Fire Warde eA 1 VZ---- <br /> Public Works <br /> -fVfnF�-CSD- --�y G•�� <br /> License Approved For: <br /> KC <br /> Remarks: <br /> yV O S ter P .T t"G � <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicationsForms&Ila ndouts/Plann ingApplications/Business License(Revised 11-14-11) <br /> Page 2 of 6 <br />