Laserfiche WebLink
APPLICATION -- BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> /i zoic <br /> to: <br /> BUSINESS LICENSE NO. <br /> c I VIII ONMWNTAIAJAUMf <br /> PFTO•BE.COMPLETED BY THE APPLICANT PRIOR TO F1bNG'THE APPLICATION <br /> Btjsint ss Informkioan•• ' <br /> Business Name: �� i C— <br /> C-M3 <br /> Business Address:' - Cross St I .C. 'R <br /> DBA Mailing Address: Sb 14 ob City: a'y-pyoState: C ZIP: <br /> Phone 9. j a 3 - 3 g Assessor Parcel Number(s): Gr 3 <br /> Email: <br /> Other Businesses at this Address: A <br /> Previous Business at Address: <br /> Description of Business Operation:: �- T• ��J <br /> Type of Organization: t&SIngleOwner ❑ Partnership ❑ Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: o2 Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: k o 0- Applicant First Name: <br /> i" <br /> Applicant Mailing Address: �(}������ ,�• f <br /> City Zr State G"A ZIP qS'17061Applicant Phone No: <br /> Water Supply: ❑Public On-site Well Sewage Disposal: ❑ Public m Septic System <br /> Will there be any sale of firearms? ❑ Yes I-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 /> ari Ing from the Own erlAgenYs project. <br /> yyl GjJjJ tv�39JaoIly <br /> •Appbcant's gnature: ! / <br /> STAFF USE ONLY <br /> G/P Designation: Zoning: J Use Type: r <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: U 3 1 <br /> Building inspection <br /> Environmental Health Div 1 t3 <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For 4--,L- <br /> Remarks: <br /> f Remarks: J� <br /> L <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicationsForms&Handouts/PlanningAppltcations/Business License(Revised 11-14-11) , <br /> Page 2of6 <br />