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3 <br /> rat't?! APPLICATION — BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> r. BUSINESS LICENSE NO. j���bVb� <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING:THF APPLICATION''.:'. `.. . <br /> Business Information <br /> Business Name: he <br /> � � A `F R <br /> ..- <br /> E <br /> Business Address: �� (L R-6 ml7 Cross St [� ( 1 — U <br /> DBA Mailing Address: ��. �j e-xv6y �l City: Aoc • . State: c ZIP:J C5'Z- <br /> Phone#: Cj 1! �� Lt Assessor Parcel Number(s): <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: <br /> . <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:t1 a_r r o Applicant First Name: - <br /> Applicant Mailing Address: o?_3 771o, I/ <br /> State(� ZI b Applicant Phone No: <br /> City !91k.lk,63 <br /> Water Supply: P�ublic ❑ On-site Well / Sewage Disposal: UJ41rublic ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes t1d No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> 1,affirm, under penalty of perjury that all the above information is true and correct Date: '3)1111,3 <br /> 1, the OwnerfAgent 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 /> Applicant's Signature: <br /> STAFF USE ONLY t, <br /> GIP Designation: C, Zoning: Use Type: <br /> DEPARTMENT APPROVED DENIED ATE !! <br /> Development Services Planner Nam <br /> Building Inspection j <br /> Environmental Health Div <br /> Fire Wafden( . fix u n d0 S <br /> Public Works <br /> M.H.C.S.D, <br /> License Approved For. <br /> Remarks: I <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 />