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( %'5 tiq 1.0 <br /> (-n) D <br /> APPLICATION - BUSINESS LIC N E <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ! BUSINESS LICENSE NO. 0-10039 <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: FVJ±r �G • L C� r �vt U l� <br /> �n <br /> Business Address: 11t4m Cross St M <br /> DBA Mailing Address: 9 City: �odous State: ZIP: `ZS'.jq <br /> Phone#: `a LY— 22 Assessor Parcel Number(s): osig a-000 <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Type of Business: <br /> Type of Organization: [jSingle Owner ja Partnership [I Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: 10 Estimated Number of Part Time or Seasonal Employees: J-5 <br /> Applicant Last Name: Applicant First Name: <br /> Applicant Mailing Address: qq� - <br /> LkA <br /> City i �i Stat, ZIP Applicant Phone No: • ate <br /> Water Supply: ❑Public On-site Well Sewage Disposal: Ely� <br /> Public -aeptic 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,all the above- mation is tru and correct Date: <br /> Applicant's Signature: \,�y` IL' (Cj <br /> STAFF USE ONLY <br /> G/P Designation: Zoning: Use Type: <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services )d Planner Name: I o2 ��]•0 <br /> Building Inspection Qj <br /> Environmental Health Dia <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For ( (� <br /> Remarks: a <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:IDevSvc\Planning Application Forms\Business License(Revised 09-12-07) Page 2 of 7 <br />