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APPLICATION — BUSINESS LICENSE <br /> i SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> `• ZQQS��� -� PBUSINESS LICENSE NO. ��loI J17-D� l <br /> ;FORS, M 2: 58 <br /> TO BE COMP r-rt LICANT PRIOR TO FILING T E APPLICATION <br /> u_ mess Information <br /> Business Name: Gp <br /> Business Address` Cross St .�— <br /> ,DBA Mailing Address: City: State: ZIP: <br /> Phone#: i ,, r Assessor Parcel Number(s): <br /> Other Businesses at this Address: <br /> 1 t <br /> Previous Business at Address: L Zo i <br /> r <br /> Type of Business: <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: Applicant First Name: U- C <br /> Applicant Mailing Address: += G <br /> City State ZIP Applicant Phone No: Zv ` <br /> Water Supply: gpublic ❑ On-site Well Sewage Disposal: Public ❑ Septic System <br /> Will there be an sale of firearms? ❑ Yes No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I,affirm,all the above information is true and correct Date: <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> G/P Designation: C Zoning: Use Type: om 0 v 3 <br /> DEPARTMENT APPROVED DENIED D <br /> Development Services Planner Name: fflo ' (}�-j <br /> Building Inspection <br /> Environmental Health Div (tLAA4j�j 17-7-05 <br /> Fire Warden <br /> Public Works <br /> Solid Waste <br /> Enforcement Officer <br /> M.H.C.S.D. <br /> License Approved For: O G1 t <br /> on o rP &i-r- L - -017-100133,S <br /> Remarks: <br /> SU 0005F0 <br /> Oce.Grp. <br /> Accepted as Complete: Date: <br /> F:\DevSvc\Planning Application Forms\Business License(Revised 10-20-05) Page 3 of 8 <br />