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IVED <br /> APPLIC�TI(JN — �UStNESS LICECFISE <br /> ' OCT SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> G 2015 <br /> BUSINESS LICENSE NO. 00 A I <br /> VIR <br /> RN ONME <br /> \cru�dcit <br /> M <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO-FILING THE APPLICATION <br /> Business Information <br /> Business.Name: <br /> Business Address: J 2 U �y i0�4 + S+ Cross St 01,0 c <br /> Tk <br /> DBA Mailing Address: —7()_�b 13-}i'( `.+ City: S.{-OC K-on State: C•A ZIP: If <br /> Phone< q gni? --e4rgS Assessor Parcel Number(sy L43 •-- DJb (/6 <br /> Email: <br /> Other Businesses at this Address: 1tZ� <br /> Previous Business at Address: Day)avyI i C <br /> Description of Business Operation:: <br /> Type of Organization: ff4 Single Owner_ ❑-Partnership 171 Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: `S Estimated Number of.P_art Time or Seasonal Employees: <br /> Applicant Last Name: Se rrat Applican#First Name: `� <br /> (6�1- <br /> 'Applicant Mailing Address: 9CQP E-7- I -� <br /> _City 0cll �py� S#ate ZIP '206 Applicant-Phone No: '�p(4 71 �St:J <br /> Wafer Supply. ub1[c ❑ On-site Well Sewage Disposal: ublic ❑ 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 /> J,affirm,under penalty of perjury that all the above information is true and correct Date: <br /> i,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 projec <br /> Applicant's Signature: r `/ <br /> STAFF USE ONLY <br /> GIP Designa8on:(� Zoning: Use Type: } PfHei ! Jo <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name <br /> la� <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden_tE_:AGTG Mt <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For. AL)+jc2 <br /> Remarks: _ Q" n <br /> Oco.Grp. <br /> Accepted as Complete: Date: <br /> F/Applica6onsForms&Handouts/Planning4pllcationsBusiness License(Revised 02-24-95) <br /> Page 2 of 6 <br />