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a"ly. Ab- <br /> APPLICATION — BUSINESS LICENSE <br /> o.P•" c <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> y BUSINESS LICENSE NO. F� <br /> '9�/FORt� <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: Tt 1 <br /> Business Address: Cr ss St _&e r4m c�v <br /> DBA Mailing Address: �y�f City: State: ZIP: <br /> Phone#: ,20 - 13 Assessor Parcel Number(s): 'L O l7 <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: <br /> Type of Organization: R) Single Owner ❑ Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: Q Esfimated Number of Part Time or Seasonal Employees: (� <br /> Applicant Last Name: ( r I C/` I Applicant First Name: <br /> Applicant Mailing Address: Z \'Z Q01 YV1Q M 1N w(A <br /> City S L State ZIP S� Applican hone No: ID - <br /> Water Supply: Ekublic ❑ On-site Well Sewage Disposal: M 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 <br /> agents,officers and employees from any claim,action or proceeding against the County <br /> arising from the Owner/Agent's project.X0 I ZI <br /> Applicant's Signature: !e� <br /> STAFF USE ONLY <br /> G/P Designation: C Zoning: L Use Type:P1 V f 0 11`�— <br /> DEPARTMENT APPROVED 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 V ����• <br /> Remarks: p, t'L- l�\rn' L- 4 Q D 0 1'1 <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F 0evSvoPlanning Application Forms\Business License(Revised 01-25-10) Page 2 of 7 <br />