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PLEA 5L Y1LOPU14U VVI 111111 1 VVU VVLc,w.
<br /> ( IC NSE SUBJECT TO ` -)PROVAL IF NO RESPONSE BY -•IIS TIME).
<br /> S N OAQUIN COUNTY _ JMMUNITY-VVELOPM D
<br /> A : OWEN (468-3230)
<br /> 1 10 EAST HAZELTON AVENUE
<br /> S'. CKTON, CA 95205
<br /> B
<br /> .,_ NO. _ 5 -2o2
<br /> RECEIPT NO. Z6 1
<br /> ANNUAL FEE:
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<br /> Business Name: T c—ct N 23o PO �4Ao Pj9%N r OBA(H different):
<br /> Business Address: f 7--2-8J' Al. BRLL t L L A 'RD v icTcR , R951 S 3
<br /> Other Businesses M this Address: 7
<br /> Phone: O 9� 3 6 c� ' O 6 Assessor Parcel Number(s): —
<br /> Mailing Address: / D Z ox (,,o7 V1'C Toe C S53
<br /> Type of Business: AUTO `BOD ,r1tlP / j
<br /> Type of Organization: X Single Owner ❑ Partnership ❑ Corporation ❑ Other:
<br /> Estlmated Number of Full Time Employees: J Estimated Number of Part Time or Seasonal Employees:
<br /> Business Owner(s) Name: `7-�1�JAl/q Z f
<br /> Business Owner(s) Address: .S6 rt�/9//1� y C d
<br /> Manager's Name:
<br /> Previous Business at Business Address: —rKi
<br /> Other Local Business Locations (Address):
<br /> Water Supply: Public ❑ On-site Well Sewage Disposal: y� Public ❑ Septic System
<br /> Will there be any retail sales of pistols, revolvers or other concealable firearms? ❑ Yes No
<br /> NOTE: ANY CHANGE OF OCCUPANCY WILL REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS.
<br /> IL Applicant's Signature: Date:
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<br /> General Plan Designation: %— Zoning: Q — 2s
<br /> OEPARTMENT APfPRRCVE2.. DENIED BY DATE
<br /> Development Services V J
<br /> Building Inspection
<br /> Environmental Health Div �
<br /> Air Pollution Control Dist
<br /> Sheriff(firearm sales only)
<br /> Fro Olstrid
<br /> License Approved For tl a Q 6 �1
<br /> Remarks: )(J h 0/6 / o-7 �>G (./a CCZI'Ir idILr
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<br /> Accepted as Complete: Date:
<br /> Copies:WHITE-Development,GREEN-Building, CANARY-Fire District, PINK-Environmental Health,GOLDENROD-APCD
<br /> PA-81-1.0 Rev.
<br />
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