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BUSINESS LICENSE <br /> V 11 ,f­:r, APPLICATION <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> DFC 9 2014 <br /> BUSINESS LICENSE NO.Yxt 14— 2 <br /> I'`NVINOPM11:N IAL 141-ALITI, <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FUNGTHF APPLICATION' <br /> Business Informa't on <br /> Business Name: <br /> Business Address: <br /> _r, rto cross St C <br /> DBA Mailing Address: City: State: <br /> Phone 9: Q DZ Assessor Parcel Number(s): <br /> IG <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: <br /> Type of Organization: Single Owner El Partnership El Corporation Ll Other: <br /> Estimated Number of Full Time Employee.. Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: 1�la Name: vrAe� <br /> Applicant Mailing Address: ?t . �0 Ij <br /> city Lkmey-) State M ZIP Applicant Phone No: <br /> Water Supply: ©Public F1 On-site Well Sewage Disposal: El Public El Septic System <br /> Will there be any sale of firearms? LJ Yes PI-No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> 1, affirm, under penalty of perjury that all the above information is true and correct Date: <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/Agent's project, <br /> Applicant's Signatu <br /> .STAFF USE ONLY <br /> GIP C; I, <br /> Designation: Zoning: _ Use Type: DATE <br /> DEPARTMENT APPROWED DENIED <br /> S vic Planner Nam IV/C7 fln <br /> Development Services XJ <br /> 1) <br /> ;p <br /> 7IBuilding Inspection A <br /> ';K, <br /> 0 <br /> Environmental Health Div L <br /> Fire Warden <br /> Publ!cWoAs <br /> M.H.C.S.D. E_ <br /> License Approved For <br /> ftAl U64- AP MOW, <br /> Remarks. <br /> narks. <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F/Appl]GationsForms&Handouts/PlanningApplications/Business License(Revised 11-14-11) <br /> Page 2 of 6 L <br />