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1-7 201q <br /> o��°►�'° j !6 APPLICATION - BUSINESS LICENSE <br /> -',`'•.O <br /> Ate JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> SSP 0 3 2015 BUSINESS LICENSE NO. -IrENVIRO <br /> MEN -ALX71=Iii,I1i <br /> FFBuM�n,ssN2,1e, <br /> - BE CO L � HE-APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Infbrmafion <br /> :s: / twd ie90Gross St__(A0A1TEt_ PP <br /> DBA Mailing Address: (`�, 0135 - City: k4pe j <br /> Phone# 0 /.f OS7— Assessor Parcel Number(s): w <br /> Emait: <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: d6IGC 77/16 401esObvL_ .S/ o Ta . 1ja±_ %ffc <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. Applicant First Name: Q�-�tE <br /> —Applicant Mailing Address: t?5- 9- 61 <br /> City �,,1 State 711P [I Applicant-Phone No (;C <br /> Wafer Supply: ❑Public ❑ On-site Well Sevmge 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,under penalty of perjury that all the above information is true and correct Date: <br /> I,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 roject. <br /> Applicants Signature: i (� ? vt r/Y <br /> STAFF USE ONLY <br /> G/P Designation: Zoning: �-�,. Use Type: 41 I�f <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: Z �� <br /> Building Inspection U <br /> q <br /> Environmental Health Div cy�G(OD/0(l2 f !,s <br /> Fre Warden () it <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For. y\.) AY �OJJJA]04 <br /> CW fetwZy4t Q0 <br /> Remarks: :t / <br /> -•,� _ <br /> vw..,.F.. <br /> Accepted as Complete: Date: F <br /> F/ApplicaUonsForms&Handouts/PlanningApplicagons/Business Ucense(Retiis&d 02-24-45) r <br /> Page 2 of 6 <br />