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ETA <br /> �att� <br /> 4ll' ` APPLICATION - BUSfNESS LICENSE <br /> >: <br /> 7AUGz��5SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> J BUSINESS LICENSE NO. 0 � , (�(�L N <br /> ImilizitHVICES <br /> TO,BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Businbss Name: b(}0)A r`.t 0A C4V <br /> Business Address: 1- 171 e" vl-my) k Cross St <br /> DBA Mailing Address: City: State: ZIP: <br /> Phone#-, ��b-��~ �S(�� Assessor Parcel Number(s): A/ <br /> Email: <br /> Other Businesses at this Address- <br /> Previous <br /> ddress: <br /> pro,. us Business at Address: 4 t l t✓ � <br /> Description of Business Operation:: y� , <br /> Type of Organization: Ingle Owner ❑ Partnership ❑ Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: j to` Applicant First Name: <br /> -Applicant Mailing Address: 9,51 'S�f-G &K�� tl (_ <br /> -city %LtYY` I Stat-e/4- ZIP 5 II Applicant Phone No: S1,0 �" b <br /> Water Supply: • Public ❑ On-site Well Setivage Disposal: Public El Septic System <br /> Will there be any sale of firearms? ❑ Yes o <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: <br /> 1,the Owner/Agent agree,to defend,Indemnify,and hold harmless the County and its l <br /> agents, officers and employees from any claim,action or proceeding against the County <br /> arising from the Owner/Agent's project. JJ <br /> Applicant's Signature: JXp <br /> STAFF USE ONLY <br /> GIP Designation: Cr- Zoning: 6— Use Type: ,u {, • e� r� t <br /> DEPARTMENTAPPROVED DENIED DATE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div 54(00!0 59 f eZo/� <br /> Fire Warden ' <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For. <br /> Remarks: <br /> z- 03 (� Oce.Grp. <br /> Accepted as Complete: Date: <br /> FlApplicabonsForms&Handouts0anningApplica6onsBusiness license(Revised 02-24-15) <br /> Page 2 of 6 <br />