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i -- <br /> 30 <br /> APPLICATION — BUSINESS LICENSE <br /> Q ? SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> w { BUSINESS LICENSE NO. <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: <br /> Business Address: j/yu j �J !.?, r�[ ( Q ✓�i p Cross St <br /> DBA Mailing Address: City: �� State: . zip: c(s j, o <br /> Phone#: `�. 'i r r L(&l I Assessor Parcel Number(s): O S U <br /> Email: 6 /"-f u <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: <br /> Type of Organization: ❑ Single Owner ❑ Partnership Corporation © Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: 2o <br /> Applicant Last Name: )",.,`,(a Applicant First Name: Irl <br /> Applicant Mailing Address: /i<t u; p, 3 n <br /> Q <br /> City f v;,I State r/T ZIP Applicant Phone No: <br /> Water Supply: ❑Public b 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 Dale: <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._---, <br /> Cl <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> G/P Designation: Zoning: - Use Type: avlts <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services >Q Planner Name: <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Wardenwma'i <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: 60r Cour <br /> Remarks: i-4,6T 'y 11- JOU„ <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F/AppllcationsForms&Handouts/PlanningApplications/Business License(Revised 11-14-11) <br /> Page 2 of 6 <br />