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APPLICATION — BUSINESS LICENSE <br /> ll,IC�il _�AQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. C::)9 <br /> 1 2009 P7 3 <br /> TO BE COMPLEMMIDE"LPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: -(hL MP')-S10dk6' qq <br /> Business Address: 410 5 tj a) L54-A U),Z,4 Cross St' )4tw4tyK <br /> DBA Mailing Address: ,p,- bry- 3 go City: 5.6ck-4,-\ State: CA zip:q526- <br /> Phone t. 20g 1q4 (-qq99 Assessor Parcel Number(s): 4 <br /> Erru"'o14 6bLk-4anqq.a)&q <br /> Other Businelses at this Address: <br /> Previous Business at Address: Wd"of mct4w-il- <br /> Type ol'Business: Q4&or HXA'�eA44-'� lay�'"Ia <br /> Type of Organization: El Single Owner ❑ Partnership gCorporation [I other. <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees; <br /> Applicant Last Name: WCCt,(.� I Applicant First Nam.: <br /> Applicant Mailing Address: pQ, 13dy- 3qo <br /> City State CA ZIP g52a1 Applicant Phone No; <br /> Water Supply: EIPublic' X On-site Well Sewage Disposal: El Public N Septic System <br /> Will them be any sale of firearms? [I Yes No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> 1,affirm,all the above Inf anon Is true and correct Date: <br /> I—V <br /> Applicants Signature. Z66tfC —lzZlw <br /> STAFF USE ONLY <br /> GIP Designation: Zoning: c—' L7( Use Type: <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: Ir-f9 <br /> Building Inspection <br /> Environmental Health Div x <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> Sheriff(Junk Dealers Only) <br /> License Approved For. 4�� -7— <br /> Remarks: ITED ka�::�62 0 1 cc.Grp. <br /> Accepted as Complete: j Date: <br /> FADev5v6PIanning Application Fo=ABusiness License(Revised LI-Oa Page 2 ok'�o <br /> r I_A-9� <br /> (6 la <br />