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i <br /> — —7 - 7 .. iQ <br /> oPa�l"' APPLICATION — BUSINESS LICENSE <br /> y.•._ .�o <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO._b(/� 17 I�� <br /> .•�P .. <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FIbk6THE APPLICATION; <br /> Business Informatloi ` <br /> Business Name:`'J �"'� <br /> d <br /> Business Address:• , Cross St <br /> DBA Mailing Address:' 6 E E R ity: State: <br /> Phone#: (9-,! / Assessor Parcel Number(s): �� O� I• (�� <br /> Email: — <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: '� L 6S' CPQ 2 <br /> s,5K lC A C s e/� v/C_C 's <br /> Type of Organization: Single Owner ❑ Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: �y(} <br /> Applicant Last Name: ��(P Applicant First Name: _00/0& <br /> Applicant Mailing Address: G'O p o" c r <br /> City S 0C State C ZIPApplicant Phone Nob Q ,j` <br /> Water Supply: Public ElOn-site Well Sewage Disposal: 9 Public ❑ 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 /> 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 <br /> arising from the Owner/Agent's projec <br /> Applicant's Signature: _ ��( ' <br /> STAFF USE ONLY <br /> G/PDesignation: � �,� [y ZonUse Type: <br /> DEPARTMENT AP-PV6VED DENIED DATE <br /> Development Services V Planner Name: a <br /> Building Inspection <br /> Environmental Health Div <br /> �^ a' <br /> Fire Warden e-f 2 <br /> Public Works <br /> License Approved For: eS <br /> I <br /> Remarks:Y001l;)C(ro <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicationsForms&Hand outs/P Ian ningApplications/Business License(Revised 11-14-11) <br /> Page 2 of 6 <br />