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_ CITY OF ESCALON <br /> Return this form with Tax to: <br /> BUSINESS LICENSE APPLICATION City of Es y Avenue <br /> �1 I RENEWAL X855 Cole <br /> —' P.O. Bax 248 I <br /> Make changes in printed information eS ! Escalon, CA 95320 <br /> NEW BUSINESS PLEASE TYPE CR PR _E <br /> (2C9)938-3556 <br /> (ai <br /> AUG 1 �Uj e AUG <br /> I-?EkTH' <br /> BUSINESS NAM r,ry���r <br /> K R <br /> SINE55 LOCATION Cpmplet Aooress.City,Stale,Zo) <br /> Gc <br /> BUSIN S�LEPHONE OWNER'S HOME TELEPHONE <br /> DATE BUSINESS-ARTED IN ESCALON <br /> NivVV1,I`S F-3 <br /> 3USINESSOWNER <br /> /'S � ca _CWNER'S SCC:AL_ _ Y N <br /> _PITUMAER <br /> s �-3) <br /> C'.E ADDRESS(Comolete Address. y State zip) �92-:e <br /> IS APoi CATIC+.I FOR "`SCLC PR A-.c <br /> J <br /> CP?�rETORSHIP U P,4RTNcFtSnir= U i',GRPOP•A-:,V _-�e-aR;,TE usT <br /> .F V.__3aARY <br /> Li (LIST ALL PARTNE? � (LIST OFFICERS 3—r-7-ES) <br /> ME)�TITLE ���� �"4� C `� <br /> HOME ADDRESS C:r- a>cdress.City.State.Sol (AREA_--_E;PHONE <br /> �,Ll fti." <br /> �yc� r!� h y3,� -NF1*1 <br /> NAME,TITIE HOME ADDRESS Cct-oa Aeoress.C.ry,Sate.Zol <br /> (AREA C,:CEI PHONE <br /> NAME.TITLE HOME ADDRESS Con-ore Addrese.Cdy.State.Zol <br /> (AREA PHONE <br /> PESALE NUMBER;80 RD(-r=ECUALZATION) STATE EMPLOYER I.D.3 <br /> =l.1P!OYER I.D.NUMBER <br /> '"'LING INFCRMATION TO CALCULATE YOUR TAX, USE CATEGORY SECTiCN C (OVER) <br /> `DAME 11e 0 In Y�. `J W�1'�.G'�,l CJ�V1 cQ <br /> NOTICE--- <br /> FBUSINSEVSS <br /> Y AN APP!;CATION. <br /> ADDRESS t ' OF CITY DEPARTMENTS <br /> CITY.LIP '-( I d�� (� RY 3EFCRE THE <br /> ES C a-ILo � C/i� .5���/ ICENSE IS SSUED AND <br /> PLEASE CHECK APPROPRIATE BOXES: OCCUPANCY IS GRANTED. <br /> YES 'EO <br /> 7 Are you renting Commercial Property to a business? If yes. complete bacK of application. (Section A) <br /> Do you pay rent for office,work station, storage, etc. space? If yes, compete back of application. (Sec`cr B) <br /> ❑ ❑ Will business be conducted in your home?(Home Occupation Permit recuired if in EScalon Call P!anri-= Dept.at 838-3556) <br /> Z Do you have any coin-operated machines(any type) on premises? If so. ^ow many? <br /> j Provide name and address of owners of coin-operated machines on bacK of application (Section B). <br />-TYPE CF BUSINESS .,Give 4ull description) <br /> e r,e W C 170 � <br /> Zr-v c k <br /> WE CANNOT PROCESS YOUR UCENSE WITHOUT A SIGNED APPLICATION. PLEASE SIGN AND DATE APPLICATION AND RETURN WITH FEE. <br /> AFFIDAVIT: I hereb 5eclare under a Ity erjury, that the reported information is true and correct to the best of my knowledge. <br /> 011 <br /> SIGNATURE I <br /> CA—ED <br /> t I I ScfAlle l � , <br /> �+ I t 1 <br /> P`C?W UENIE= 3Y REASC•. <br /> OFFICE USE ONLY ='INNING <br /> RECEIVED BY =L".LOING <br /> _ DATE <br /> CASH ^ Q1^E DEPT. <br /> AMOUNT RECEIPT x CHECK C ='_3LIC'NORKS <br /> -EALTHDEPT <br /> SIC CODE ARTICLE CHAPTER <br /> =- !CE DEPT. i 6 - <br />