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I r t cz `°`''`° <br /> IZ:R V L__P <br /> APPLICATION BUSINESS LICENSE <br /> JUN 2013 <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> 6 <br /> i. <br /> 13USINESS LICENSE NO, <br /> ENV(" <br /> MAP XCH <br /> tu% hTALHIE <br /> TdOECOMPLETED BY THE APPLICANT PRIOR TO FILANGTHE APP.LICATION'*. <br /> BlUsIn6,§S InformMion, . .777 <br /> Business Name: #/J Y V(qlq /9 1)r2l7 <br /> Business Address: Cross St <br /> DBA Mailing Address: city: Ze-)c <br /> e ?-* 7- 7.-- Assessor Parcel Number(s): 0) 9 0 2-0 <br /> Email: <br /> -Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation.: <br /> Type of Organization: Single Owner [I Partnership El Corporation El Other. <br /> Estimated Number of Full TVs Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: Applicant First Name: <br /> Applicant Mailing Address: -v 0 4— <br /> City L—o G State 0.I/\ ZIP -L Applicant Phone No: <br /> Water Supply. []Public El On-site Well Sewage Disposal: [] Public E] Septic System <br /> Will there be any sale of firearms? [I Yes No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY RE IJIRE 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. ���/ Jl /� <br /> Applicant's Signature: <br /> -.STAFF USE ONLY <br /> GIP Designation: Zoning: <br /> use Type: -9 't Yee-Z/ <br /> 1 <br /> E <br /> DEPARTMENT APPROVED DENIED DTE <br /> Development Services Planner Name: .3 1�1 27— <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden VAO <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For. <br /> Remarks: <br /> 1 Ck e,-e-S" To <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F/Applir,ationsForms&Handouts/PlanningApplicationsA3usiness License(Revised 11-14-11) <br /> Page 2 of 6 <br />