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e� <br /> ,DESS•LICENSES <br /> & DANCE PERMITS <br /> • ----�y,� ; �� COUNTY Control No. <br /> UATE ( �' Date License Issued <br /> 111 f APP Q�PL <br /> B. L. No.SIG N Thi <br /> PLEASE REVIEW&A AND <br /> BACK TO f��e ipl No. ,.?Dd`�°^' <br /> FOR APPROVAL WITHIN 5 DAYS- �' � 1) 1 Yr. '—' 3 Yr. O <br /> COUNTER CLERK t A (� 1r1n <br /> Tl <br /> THANK <br /> YOU- Z 111 rrrv'ENTAL HLALTH <br /> PERMIT/SERVIC-g <br /> MART I E <br /> Phone: <br /> Business Address: \ A\ <br /> Other Business at Address: <br /> Assessor Parcel Number(s): <br /> Mailing Address: <br /> Type of Business: <br /> o <br /> Will there be any retail sales of pistols, revolvers or other concealable firearms? ❑ Yes Flo (If yes, Sheriff's Office <br /> review is required.) <br /> Type of Organization: Single Owner, ❑ Partnership, ❑ Corporation <br /> Estimated Number of Employees: ` Full time, Part time cr Seasonal <br /> Owner(s) Name: pA)A ip— A <br /> LiAOwner(s) Address: ti � V�6.�� $� UTILITIES <br /> Manager's Name: WATER: Public V Well ❑ <br /> Previous Business at Address: Sanitary: Public l%Septic ❑ <br /> Other Local Business Ad ss(es): 5p <br /> Applicant's Signature: v Date: I <br /> STAFF USE ONLY ' <br /> P-7 Zoning: "- R� Section No.: — ��� z General Plan: P,t, <br /> Department Approved Denied By� / Date <br /> Planning Division ❑ <br /> Building Division ❑ ❑ <br /> Fire District ❑ ❑ <br /> Public. Works I �❑,/ ❑ <br /> Environmental Health Div. ❑ 5 ;�Mgt <br /> Air Pollution Control Dist. ❑ ❑ <br /> ,Sheriff (firearm sales only) ❑ ❑ <br /> License Approved For: 1�2 v , �u IDYL�i <br /> Remarks: 4_ 21f <br /> ., Accepted as complete on: By: <br /> Copes: WHITE-Planning, BLUE-Building, GREEN-Fire District, GOLDENROD-Public Works, PINK-Env,romental Health Div., CANARY-APCD PLANNING 21 (9190) <br />