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APPLICATION — BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ` BUSINESS LICENSE NO. <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: Fe wa F116L 4P 970 <br /> Business Address: mu W65716 <br /> DBA Mailing Address: 0`rp S 65. city: Mom x � State: A Z zip: 0 -9 96 <br /> Phone#: 62A _ 90-3577 Assessor Parcel Numbens): <br /> Emait G ALE S FE W <br /> Other Businesses at this Address: Al <br /> Previous Business at Address: N <br /> Type of Business: FOE L s7raV0jj <br /> Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: SA EG SVA INCApplicant First Name: <br /> Applicant Mailing Address: `�� 17' N, 911- VG, <br /> City ptiCEN14State ZIP 50 Applicant Phone No: p - 1472 - 6Q,0 <br /> Water Supply: gublic ❑ 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,all the above information Wlstrm" 8ncorrect Date: <br /> Applicant's Signature: 6wL.��_ o 7 <br /> STAFF USE ONLY <br /> GIP Designation: G�C, Zoning: c: - CG Use Type: <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health I Z-17-01 <br /> Fire Warden <br /> Public Works <br /> License Approved For: _ l V t,r -) <br /> Remarks: <br /> 5uDG1? 8g <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> FdDevSvelPlanning Application Forms\Business License(Revised 0942-07) Page 2 of 7 <br />