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PqU{N APPLICATION — BUSINESS LICENSE <br /> �= SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. <br /> R�/PORN <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: h - 1 L.r re sC-\ '\ '\%r e �-,-rv•�e e- <br /> Business Address ���I F- t�1 �Ytic,�i,x',�t A\(6° Cross St <br /> DBA Mailing Address:"( 4 Ej N ���^�w' City: > Lh tC�rl State:�A ZIP: �1� c�S <br /> Phone Assessor Parcel Number(s): 3- <br /> Email: <br /> Other Businesses at this Address: _ 1 <br /> Previous Business at Address: <br /> Description of Business Operation:: 1 <br /> Type of Organization: ❑ Single Owner [Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: 44 Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: A Applicant First Name: t4 --)-�- l A A to-3 i \ <br /> Applicant Mailing Address: C i r--.v <br /> City , b--v.-ti V\ State<:--P ZIP {' a I]_ Applicant Phone No: 6\-- �'� � CI", \ <br /> Water Supply: ❑Public ❑ 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 Date: 4$"— 61 G �� <br /> 1,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/gent's proje j. <br /> Applicant's Signature:1 ` -� <br /> STAFF USE ONLY <br /> G/P Designation: (, Zoning f Use Type: .S l�l V-'0 � rLl Y C( �� <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: U <br /> Building Inspection <br /> Environmental Health Div S (a <br /> Fire Warde 71x-&1/1/ U Z4{- <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: <br /> U $q-tc-1c -x' meiurl to J t <br /> Remarks: Lo <br /> Y1l,c1 kA w C_ c f L Occ.Grp. <br /> Accepted as Complete: Date: <br /> F\DevSvc\Planning Application Forms\Business License(Revised 01-25-10) Page 2 of 7 <br />