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�. f` I <br /> APPLICATION - BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. 1_� 1 i v <br /> �.''iun•at+� <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: Lr- <br /> Business <br /> .Business Address: Cross St <br /> DBA Mailing Address: City: , State: ZIP:G 2,,31 <br /> Phone#: 13 0 C, _ C' _ 1� Assessor Parcel Number(s): ye f "'' 3S-0 _ 4 eiLt/X' <br /> Email: ^' i. <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: !��f` �` i I ,�, f �l1; �, ; ' T, ii - ,- L,he <br /> J <br /> A 111 <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: 6rAApplignt First Name: <br /> Applicant Mailing Address: O. !=F J V Ct t_ IEALTH <br /> CityState rA ZIP 2 Applicant Phone No: "'j{}-&)Y-)- ^ 0 <br /> Water Supply: OPtublic On-site Well Sewage Disposal: ❑ Public (H 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 <br /> agents,officers and employees from any claim,action or proceeding against the County <br /> arising from the Owner/Agent's project. <br /> , <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> G/P Designation: L Zoning: — L Use Type: <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: [J , S r•,nr�: �, _> Z �1 3r/ / <br /> Building Inspection <br /> Environmental Health Div y✓� 111 �' 7 <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For. J, (< c ,r�;.�1~ (� ✓ — `i Sal o — ; r�t��t c `� <br /> 5 c �5 C)iti o- <br /> Remarks: <br /> CLt Tfi c �5 c_ %�,�k c+•� z( �,71, �' ,,, i Ile:' J�LC�:� 1 <br /> �Z �/7C1 A� 1 i - ?e_ c)��C. ,'�T•1.� 1 . li 1�,.,* t c�. Occ.Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicationsForms&Handouts/PlanningApplications/Business License(Revised 02-24-15) <br /> Page 2 of 6 <br />