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oPg�t" APPLICATION - BUSINESS LICENSE <br /> r SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> N' ,`• BUSINESS LICENSE NO. <br /> eq. �>.�P <br /> <<FORa <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: > � \ <br /> Business Address: (A. Cross St Y <br /> DBA Mailing Address: r�, �X Z City: 1 State: CA ZIP:qSzlt <br /> Phone#: Assessor Parcel Number(s): (J� <br /> Email: Z <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: �1i1 1e SU cj <br /> Type of Organization: 0 Single Owner ❑ Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employee's: <br /> Applicant Last Name: ':r +-Y-e Applicant First Name: v <br /> Applicant Mailing Address: (> 0 x 2 0 <br /> City 1 State Dt\ ZIP C) q Applicant Phone No: <br /> Water Supply: Public ❑ On 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 an claim,action or proceeding against the County <br /> arising from the Owner/Ae s project. <br /> Applicant's Signature <br /> STAFF USE ONLY <br /> G/P Designation: L Zoning: — Use Type: u))\.;)u3 Grp <br /> DEPARTMENT APPROVED DENIED .DATE . <br /> Development Services Planner Name: !� <br /> Building Inspection I q <br /> Environmental Health Div la <br /> Fire Warden L�`fd <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: <br /> Remarks: no <br /> Occ.Grp. <br /> lAccepted as Complete: Date: <br /> F:\DevSvc\Planning Application Forms\Business License(Revised 01-25-10) Page 2 of <br />