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CITY OF ESCALON <br /> -" _ Return this form'Neth Tax to: <br /> City of Escalon <br /> J BUSINESS LICENSE APPLICATION 1855 Coley Avenue <br /> �I RENEWAL „p P.O. Box 248 <br /> Make changes in printed information Efesff <br /> Z r Escalon, CA 95320 <br /> NEW BUSINESS �Z v,;,, I (2C91 938 3556 <br /> PLEASE TYPE OR PRIN ' <br /> AUG 14 M01 <br /> y-1-A (a-vi Qc��CCi_�:tt`VIRONMENTAL HFA!JH <br /> BUSINESS NAM F 2 On. <br /> atS;NESSLCCAT(CN C�mplet Acaress.C,ty.State.Zip) <br /> BUS N LEPHONEOWNER'S HOME TELEPHONE DATE BUSINES -ARTED IN ESCALON <br /> 1,j e V\.C. � �3"s( -S y� <br /> E SiNESSOWNER <br /> <br /> <br /> C'..E.ADDRESS(Comolete Aadress.C,y.�S.tate.zip) <br /> !S S.ODI! ATICNI AOR .SOLE PRCF^iE,ORSHiP U PARTNERSHIP j I CORPORA `' E'N A V _= sa RY"RATE L;37,L;37,_ (LIST ALL PARTNE � (LIS TOFFICERS 3---=S) <br /> NAME.TITLE HOME ADDRESS ccs ,e.aaamss,City.State.LDI �L (,�,- (AREA PHONE <br /> NAME,TITLE HOME ADDRESS Ccrr Acaress.City.Sate.Lot !AREA::CCE"PHONE <br /> VAME TITLE HCME ADDRESS Care Aaaress.C.ry,Sate.Zol (AFEa .E':RHONE <br /> RESALE NUMBER•BO RD cF ECU'AL ZATION) STATE EMPLOYER I.D. -c c -_=!APLOYER I.D.NUMBER <br /> TO CALCULATE YOUR TAX, USE CATEGORYIN SECTICN C (OVER) <br /> IL:NG iNFCRMATiGN NOTICE�1wiat o <br /> NAME Die Y\ W'�Y`G\ 'o_VN CQ THIS IS ONLY AN APP!KATION. <br /> .ADDRESS f� t I � � APPROVAL OF CITY DEPARTMENTS <br /> CIT( 'IP t "[ mow IS NECESSARY 3EFCRE THE <br /> E7s c If BUSINESS LICENSE iS ISSUED AND <br /> OCCUPANCY IS GRANTED. <br /> PLEASE CHECK APPROPRIATE BOXES: <br /> YES NO <br /> Are you renting Commercial Property to a business? If yes,complete bacK of application. (Section A) <br /> F7 l � Do you pay rent for office,work station, storage, etc. space? If yes, comclete back of application. (Sec_-cn 3) <br /> 71 17, Will business be conducted in your home?(Home Occupation Permit required if in EScalon Call P!anrlr_ Dept.at 838-3556) <br /> Do you have any coin-operated machines (any type) on premises? If so. how many? <br /> Provide name and address of owners of Coln-operated machines on baCK of application (Section B). <br /> TYPE CF BUSINESS tGive 'ull description) <br /> G e r`e _D 170 <br /> c �nj_ `r�—�-5 �P�X <br /> WE CANNOT PROCESS YOUR LICENSE WITHOUT A SIGNED APPLICATION. PLEASE SIGN AND DATE APPLICATION AND RETURN WITH FEE. <br /> AFFIDAVIT: I hereb declare under a Ity erjury, that the reported information is true and correct to the best of my knowledge. <br /> SIGNATURE CA-D <br /> z <br /> _. hPPRCVc'p CE III E= 3Y RE>SC', <br /> OFFICE USE ONLY - =INNING <br /> 9C'LCING I <br /> RECE!\:ED 9Y DATE I \\ <br /> CASH �,. .= E DEPT. <br /> AMOUNT RECEIPT,*--- CHECK -_EUC WORKS <br /> -EaLTHDEPT. OiC' U `"C V� .S• .}'.21-..1..-c r;T",.� <br /> SIC COLE ARTICLE CHAPTER <br /> =C^_:CE DEPT. / j <br />