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1 <br /> APPLICATION - BUSINESS LICENSE <br /> r. SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO.� <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: l (� <br /> Business Address: Cross St <br /> DBA Mailing Address: L, Cl. City: State: ( ZIP: -665 <br /> Phone#: y 0 Z Assessor Parcel Number(s): O <br /> Email: , Qb <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: 516#_ j a Q 7, e <br /> \red • dvy�'L� u�lti.�e\ . <br /> Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: a Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: A` C Applicant First Name: v ly1 <br /> Applicant Mailing Address: Z \ Q A <br /> City State ZIPCJCXS Applicant Phone No: (�� <br /> Water Supply: ublic ❑ On-site Well Sewage Disposal: 0-FTublic ❑ 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 /> 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. <br /> - ��J3ol � o <br /> Applicant's Signature: llj� Wd OV\ � ' A p-, �y— e Wkte�5 <br /> STAFF USE ONLY LAc, IX <br /> G/P Designation: Zoning: C, C1 Use Type: r J �' VIA, <br /> 1 <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services !" Planner Name: <br /> Building Inspection <br /> ikiz <br /> Environmental Health Div ( o <br /> Fire Warden S( jam <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For: 1\fe d o t rc &. r_ <br /> S 4 <br /> Remarks: <br /> 4-eIqt< _ 1 <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F\DevSvc\Planning Application Forms\Business License(Revised 01-25-10) Page 2 of 7 <br />