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,�P° •. APPLICATION — BUSINESS LICENSE <br /> e i SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. - I <br /> 4TiF oa�'�P <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: 7-0-Pt r d� V <br /> Business Address: 6YAW Ai L, J TIS- QL Cross St L <br /> DBA Mailing Address: PO 6L1 City: L-0a i State: (f(f} ZIP: 4Sa4b <br /> Phone#: O $6 v"r (A- Assessor Parcel Number(s): OS'I - ^ <br /> Email: qMC4, ( GCM <br /> Other Businesses at this Address: <br /> Previous Business at Address: r R �QQy <br /> Type of Business: 1613tHL�1 J- <br /> EN <br /> Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: E 'mated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: ,c� , / Applicant First Name�n:r lC^ <br /> Applicant Mailing Address: .�j N OC ✓�c `CC <br /> City r Stateo/. ZIP Applicant Phone No: 165-(4tif-33S-C <br /> Water Supply: ❑Public On-site Well Sewage Disposal: ❑ Public xSeptic System <br /> Will there be any sale of firearms? ❑ Yes No <br /> NOTE: ANY CHANGE OF OCCUPANCY M Y REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I,affirm,all the above infor ation is true and macoo/rrect Date: <br /> Applicant's Signature: rL ( — <br /> STAFF USE ONLY <br /> GIP Designation: Zoning: (7 Use Type: v IYlGh C,f ¢ <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> Sheriff(Junk Dealers Only) <br /> License Approved For: <br /> Remarks: O <br /> Ip Ob <br /> Ox.Grp. <br /> Accepted as Complete: Date: <br /> F:)DevSvc%Plannmq Applicator,Forms\Business License(Rew sed 03-09-09) Page 2 of 7 <br />