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APPLICATION — BUSINESS LICENSE <br /> o... <br /> ? - SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. <br /> 9t;F�NN <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name lhtmmcoL d <br /> Business Address: Ll Lit) U t,.1 rjJl ftVri Cross St <br /> DBA Mailing Address: Po %17' City: P P r j G Bele: CA ZIP 6 <br /> Phone#: O9 ' 936 -SoE)I Assessor Parcel Number(s): 1 ��L (((J 0 <br /> Email JO' d e fjV�uL\4tlCtiflW <br /> Other Businesses at this Address: <br /> Previous Business at Address: 80 W LIN F _ <br /> Description of Business Operation:: — p <br /> Type of Organization: ❑ Single Owner Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: j Q Estimated Number of Part Time or Seasonal Employees 1 <br /> Applicant Last Name: JAN r-w I Applicant First Name: <br /> 'eJ�1,4 <br /> Applicant Mailing Address: j► uSl11jr k4 , LT HI►I CII <br /> City I State I ZIP Applicant Phone No: r, 10 S�W I l7 <br /> Water Supply: ErPublic ❑ On-site Well Sewage Disposal: i-7 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, o defend,indemnify,and hold harmless the County and its <br /> agents,officers ;ned <br /> em I yee rom any claim,action or proceeding against the County I O I I O <br /> arising from the nt' oj6cj. <br /> Applicant's Signature: l AV— <br /> STAFF USE ONLY <br /> GIP Designation:T �, fi C, Zoning: _L' i 'r (, H c Use-Type: L' ('r) I f)cJ --)n 4ef m <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: --,D Lb <br /> Building Inspection <br /> Environmental Health Div V y <br /> Fire Warden SU 000l) <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: -f <br /> r r�vl/\JC <br /> Remarks: <br /> /U" b <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> FM)evSvc\Plaming Application FormslBusiness License(Revised 01.2570) Page 2 of 7 <br />