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APPLICATION -� EINESS LICENSE <br /> AN JOAQUIN COUNTY COMMUNITY DEVT DEPARTMENT <br /> VEDOBUSINESS LICENSE N01 <br /> MAY 0 G 2009 <br /> LIFOg� <br /> . TO BETE APPLICANT PRIOR TO FILING THE APPLICATION=-- <br /> Business Information <br /> Name: f,_ � ^ <br /> Business Na Lakz 5 kT <br /> Business Address: 0. I Q�J Cross St S D f'7 <br /> City: fZJC'«�Il/'t State:( ZIP: <br /> DBA Mailing Address: Q f7'�C37�, G <br /> Phone# -OF(�1I� dU� a ssessor Parcel Number(s): ,Z d <br /> Email: <eqqVS <br /> other Businesses at this Address: <br /> Previous Business at Address: <br /> Type o#Business: <br /> r " <br /> Type of Organization: ❑ Single Owner ❑ Partnership s , Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: �C( Applicant First Name: <br /> Applicant Mailing Address' / a (!6 <br /> City f�C�/ Stat/�' Z ��� Applicant Phone f — ep <br /> Water Supply: ❑Public B Oil-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 is true and correct Date: <br /> Applicant's Signature: g U i 1 <br /> STAFF USE ONLY <br /> Glp Designation: �� Zoning: Use Type: <br /> DEPARTMENT APPROVED DENIED (IDATE <br /> Development Services Planner Name: l <br /> Building Inspection <br /> Environmental Health Div S' 6 162 <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> Sheriff(Junk Dealers Only) <br /> License Approved For: <br /> Remarks: <br /> 7 <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:1DevSvc\Planning Application Formsl8usiness License(Revised 05-01-08) Page 2 of 7 <br />