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M- APPLICATION -- BUSINESS LICENSE <br /> �•�`''j :� Sip 2014 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENTDEPARTMENT <br /> BUSINESS LICENSE NO. CJZ `I�J 0 2- <br /> ENVIRONMENTAL HEUH <br /> PERMITISERVICFS <br /> TO'BE C(OM-PLETED$W THE APPLICANT PRIOR TO FILING:THE APPLICATION'' <br /> c� I:30siness Infarmlation <br /> Business Name: ,S, SAG I !(� i l f <br /> Business Address:' I g '�� z-} V T vi� Cross St 1+w 131b <br /> Mailing•AddresS. -- <br /> PhoneA. (' r Assessor ParcelNumber(s): 0' z < <br /> l r <br /> 57 21— <br /> Email: <br /> Other Businesses at this Address: /V0/1A2 <br /> Previous Business at Address: ,r/0-7- AA `GWYIII <br /> Description of Business Operation:: I�UVLO"77VC- 7-//?- <br /> Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: Acle Ue-l-A Applicant First Name: e-7)qr3i2fe L <br /> Applicant Mailing Address: Iq 7 10 �(f,Gni i✓ �Z cJ r7 2 '7 <br /> City LOC*?,, i 0 State &,4 I ZIP Applicant Phone No: <br /> Water Supply: JRPubllc ❑ On-site Well Sewage Disposal: ;4 Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes 34 No <br /> NOTE:. ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I,affirm,under penalty of perjury that all the above information is true and correct Date: <br /> 1,the Owner/Agent agree,to defend,indemnify,and hold harmless the County and Its <br /> agents,officers and employees from any claim,action or proceeding against the County <br /> arising from the OwnerfAg <br /> .eFys project. <br /> } r <br /> Applicant's Signature: «rte <br /> .STAFF U$E ONLY <br /> GIP Designation: C Zoning: s Use Type: - <br /> DEPARTMEN� APPROVED DENIED DATE f <br /> Development Services Planner Name: _ y <br /> Building Inspection <br /> Environmental Health Div f dex (q- <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For. <br /> I C <br /> Remarks: <br /> e 0 63 -92 - I 3 04- 20 - 0 r' J Occ.Grp. . <br /> Accepted as Complete: Date: <br /> r <br /> F/ApplicationsFormt;&Handouts/PlanningApplicationsBusiness License(Revised 11-14-11) <br /> Page 2 of 6 <br />