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PAX V.IN•.co APPLICATION - BUSINESS LICENSE <br /> Q1 � •a <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ,,�� BUSINESS LICENSE <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: 2� 2e 00 1 1- <br /> Business Addr--- <br /> BusinessAddr--- " I-0 — t) i Cross St C- ` <br /> n <br /> DBAMailingAndress ZSV�O N ki-LI-i_ P-Pi ✓�c11hP City: c-4rv. U Stale: C ZIP: 5ZZd <br /> Phone#: O`� d -_ - ri7t� Assessor Parcel Number(s): 1 <br /> Email: N 0 , <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operafion:: R ,� <br /> Type of Organization: XSingle Owner ❑ Partnership ❑ Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees <br /> Applicant Last Name: DO W b1c"R Applicant First Name 7`o t✓ <br /> Applicant Mailing Address: 2 5 U5 0 N. P eco r L R f3 A--G•vh P U CA r-f 7-ZO <br /> City Cf(nf)o StateCA I ZIP S Applicant Phone No: 2Cy-- zlo �Yjlj <br /> Water Supply: XPublic ❑ On-site Well Sewage Disposal: ❑ 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 project. r <br /> Applicant's Signature: �Z <br /> STAFF USE ONLY <br /> G/P Designation: I, <br /> Zoning: Use Type: t y-- Ie <br /> DEPARTMEN APPROVED DENIED DATE <br /> Development Services Planner Name: 2 ( J <br /> Building Inspection <br /> Environmental Health Div ¢ v <br /> Fire Warden ' Z <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For ` - <br /> Remarks: AAD 1� � G L� l�(/�1 S V1.� d LJmae! <br /> V`7 L r I L) ( ( � �— Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:1DevSvcTlanning Application Forms\Busmess License(Revised 01-25-10) Page 2 of 7 <br />