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APPLICATION — BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMFNT nFPARTMENT <br /> 0 owo2�v <br /> �., BUSINESS LICENSE NO. <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business I formation <br /> Business Name: <br /> Business Address: Gross St ,. <br /> DBA Maili Address:( a City: Stat ZIP: <br /> Phone# Assessor Parcel Number(s): <br /> Email. <br /> Other Businesses al this Address <br /> Previous Business at Address <br /> Type of BuSHIE�sS — CA� L __ <br /> 1 <br /> ypto o`Or qanization ❑ Single Owner ❑ P nership Corporation ❑ Other, <br /> Estimated NUmber of Frill Tpe Employees Estimated Number of Part Tiry or Seasonal Employees: <br /> {� Applicant Last Name: Applicant Frst Name: <br /> 111!1 applicant Mailing Add ss- <br /> a <br /> ZIP(M I/f Applicant Phone No: f — <br /> —Water SuPPIY ❑Public �On-site We: oral: Public Septic Ssten, <br /> i` Will there be any sale of firearms? ❑ Yes No <br /> I <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> f I, affkm,all the above it rrnation is true and correc Date: K-7 i (O((i V,}l <br /> Applicant's SignatureU�MMAJ'41 _ <br /> STAFV USE ONLY <br /> G/P Designation: Zoning: ,. L Use Type' P ! --Vj( -S <br /> DEPARTMFN-f APPROVED DENIED V S DATE <br /> Development Services Planner Name: "a J <br /> Building Inspection <br /> Environmental Health Divi Z <br /> Fire Warden <br /> Public Works <br /> M.H.0 S.D. Q Ll <br /> Sheriff(Junk Dealers Only) <br /> License,Approved For. 7 <br /> ENVIRONMENTAL HEALI n <br /> Remarks <br /> Ir Occ Grp. <br /> Accepted as Complete. Date: <br /> F\DevSvc\Planning Application Forms\BLISiness License(Revised 09.01.09) Page 2 of 7 <br /> r V + <br /> { 4J 1Y <br /> t <br />