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APPLICATION - BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> FFIR 0 1 26.1 <br /> i' W <br /> BUSINESS LICENSE NO. <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: A- 4-0.,"7, <br /> Business Address: -3--3(o V)"-)A Cross S t <br /> _1 <br /> DBA Mailing Address:13-531., C)4'43W4C611; City: Loc k-,f-fo-j state: (-A zip: <br /> Phone#: )C)q - O 9 - 4L4\,ob Assessor Parcel Number(s): D/ 9 - <br /> Email: GV ,-e- <br /> Other Businesses at this Address: <br /> Previous Business at Address: r <br /> Description of Business Operation:: ALA�,,4, i< cron .-r . <br /> Type of Organization Single Owner ❑ Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: a Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: Applicant First Name: <br /> -Applicant Mailing Address- 5-% <br /> -1 -71 P Applicant-Phone No: <br /> City State-(�A 2?12 91 <br /> Water Supply: LPublic El On-site Well Sewage Disposal: P Public El Septic System <br /> Will there be any sale of firearms? 0 Yes PK 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 \v <br /> agents,officers and employees from any claim,action or proceeding against the County <br /> OTE_ ANY CF <br /> affirm, <br /> under ffl r ' ' <br /> I the Ownerl <br /> g S,offic <br /> agents, e <br /> t <br /> arising <br /> rising from the Owner/Agent's project. <br /> ,4�.���nYs Siy�nah tie: �i1 <br /> STAFF USE ONLY <br /> GIP Designation: 4;Z C Zoning: Use Type: li.A() <br /> k- CAI r <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building.inspedfian <br /> Environmental Health Div OV-\ �kt 107-7-5 <br /> I R <br /> reWarden <br /> arden <br /> MOVEL <br /> UMwe <br /> Public Works <br /> M.H.0.S.D. <br /> License Approved For. <br /> Remarks: <br /> 1 '7 <br /> 7 3' 8/_ C) 2-3 Q Occ.Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicabonsForms&Handouts/PlanningApplicatons/Business License(Revised 02-24-15) <br /> Page 2 of 6 <br />