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APPLICATION - ,USINESS LICENSE <br /> � -Y„"ca••.o <br /> _` ' % SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTM T <br /> BUSINESS LICENSE NO. y I� <br /> TO BEMP THE APPLICANT PRIOR TO F..IL1N� THS APPLICATION <br /> Business Information "� <br /> Business Name: <br /> Business Address: t V Cross St <br /> DBA Mailing Address: L. 0 City: S G State: c, ZIP: <br /> Phone#: ® 13& Assessor Parcel Number(s): 3 Ilp <br /> Email: G ,r.. ,(, Lky a,,C-0 <br /> v" <br /> Other Businesses at this Address: Ee <br /> Previous Business at Address: /� �(v'e) �u �r'� <br /> Description of Business Operation:: 1 91 rluu 012 <br /> VIR <br /> DEPARTMEN <br /> Type of Organization: ❑ Single Owner 1AL Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: Z• Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: ' Applicant First Name: vi L��-- <br /> Applicant Mailing Address: L40so ^ <br /> City S h 1 State C A ZIP Applicant Phone No: p rlR 14O �( <br /> Water Supply: Public ❑ On-site Well Sewage Disposal: 9 Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes 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 /> I, the Owner/Agent agree, to defend, indemnify, and hold harmless the County and its / 2 <br /> agents, officers and employees from any claim, action or proceeding against the County <br /> arising from the Owner/Agent's project. <br /> Applicant's Signature: U(JL,,-. 4V I <br /> STAFF USE ONLY <br /> G/P Designation: ILZoning: Use Type: lS j t^f <br /> DEPARTMENT APPR ED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> environmental Health Div <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: `f J e L - (J i p <br /> Remarks: ) / <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicationsForms&Handouts/PlanningApplications/Business License(Revised 11-14-11) <br /> Page 2 of 6 <br />