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• • 00 q-11-10 <br /> .-Cku I N <br /> ..... APPLICATION - BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO./"\_'J <br /> IF:0 R <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: AW-zf--vC) <br /> Business Address: ig?,32— c-sr,St <br /> City: , <br /> State: C,6 ZIP:15 26_C, <br /> Phone#: (,7 co Assessor Parcel Number(s): <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: ,r <br /> Description <br /> Description of Business Operation:: <br /> ShS7 le :7� Y_ <br /> Type of Organization: _4e Single Owner I—] Partnership El Corporation El Other: <br /> Estimated Number of Full Time Employees: _ Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: V Q Applicant First Name: M0---\C., <br /> Applicant Mailing Address:116-7 01k licvMul 6\vd, <br /> City State ()R ZIP Applicant Ph.,.No: <br /> Water Supply: ,RPublic E] On-site Well Sewage Disposal: Pr Public El Septic System <br /> Will there be any sale of firearms? 0 Yes No <br /> NOTE: <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 Signature: <br /> STAFF USE ONLY <br /> GIP Designation: Zoning: Use Type: <br /> C <br /> DEPARTMENT APPROVED DENIED DATE <br /> —MwxDevelopment Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: <br /> Rema,ks:VAX��V� -IT - <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:\DevSvc\Planning Application Fonns\Business License(Revised 01-25-10) Page 2 of 7 <br /> 17 U <br /> I L I <br />