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Uk ry. <br /> APPLICATION BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. 61 �O3�Z <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: w <br /> f)UMAJ C I XC,-X K U) <br /> ,Q T CC(_5 <br /> Business Address: ?�qq -S. C&DOM 00 ST. Cross St <br /> DBA Mailing Address: City: Glo(,}) State: CAr I ZIP: <br /> Phone#: Assessor Parcel Number(s): 4-7 6-- 02-1-/- 03 <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: 1((j 5000 <br /> Type of Business: <br /> Type of Organization: eSingle Owner [I Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: 7iT6/� Applicant First Name: Jom C_ <br /> Applicant Mailing Address: <br /> City LWOE-k) State G9, ZIP Applicant Phone No; Zq q()S- S-6 iF <br /> Water Supply: Public El On-site Well Sewage Disposal: El Public El Septic System <br /> Will there be any sale of firearms? E] Yes No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS, <br /> 1,affirm,all the above information is tru a d correct Date: <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> GIP Designation: Zoning: Use Type: <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: 57- (:�a <br /> Building inspection <br /> Environmental Health Div tfi <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: <br /> cl <br /> Remarks: 6) 3 2 <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:M)evSvc\PIanning Application FormsNBusiness License(Revised 10-02-09) Page 2 of 7 <br /> I L <br />