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a <br /> APPLICATION - BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ►a <br /> r`. PH <br /> BUSINESS LICENSE NO.1205 AUG <br /> �`�� JL5✓ <br /> FaR� <br /> F� d.t'A✓t ^"'S. } -Q� e +� � iY�^ F' � 1� .�q 5 If f O P r.S 'ia3 <br /> Business Name: <br /> Business:Address Cross St �i✓/}jG ,�DQ <br /> DBA tUlailirgAddress;� Z City: State: , ZIL':� 31h� <br /> Phone#:209 - /q/# Assessor Parcel Number(s): — f o 43 <br /> Other Businesses at this Address: <br /> Previous Business at Address: N <br /> Type of Business: r� <br /> Type of Organization: ((Single Owner ❑ Partnership ❑ Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: 3 Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: Applicant First Name: (�& <br /> Applicant Mailing Address: A10 3 y <br /> City C ejoAl I State ZIP Applicant Phone No: <br /> Water Supply: [+Public ❑ On-site Well Sewage Disposal: [9-Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes O No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I,affirm,all the above information is true and correct Date: <br /> Applicants Signature• S <br /> STAFF USE ONLY <br /> G/P Designation: Zoning: Use Type: <br /> DEPARTMENT APPROVED DENIED DTE <br /> Development Services ;! Planner Name: <br /> Building Inspection <br /> Environmental Health Div �O <br /> Fire Warden <br /> Public Works <br /> Solid Waste <br /> Enforcement Officer <br /> M.H.C.S.D. <br /> License Approved For: <br /> Remarks: { Lk'41­r 5f'4116) <br /> / Occ.Grp. <br /> Accepted as Complete: 1 Date: <br /> F:\DevSvc\Planning Application FormsTusiness License(Revised 07-28-04) Page 3 of 8 <br />