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I -1 <br /> APPLICATION - BUSINESS LICENSE <br /> �O.•'•• ��.CG <br /> r' ;lcy 2 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> •• -- BUSINESS LICENSE NO.a <br /> c�crF�Ra`�/ <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name (f,(�G/ 'T %QEs S <br /> Business Address: 2-5-3 7 Cross St ;-7ZI lel <br /> DBA Mailing Address: & Abt,,ILE City: S TpG/ 'fir StateCoq ZIP:9 j261s <br /> Phone#: -2- e,, _ Z Assessor Parcel Number(s) Gk `yo <br /> Email: / x L CO- <br /> Other <br /> Other Businesses at this Address. yj <br /> Previous Business at Address: <br /> Description of Business Operation:: EG,/ t SF2 ✓ 5-C <br /> Type of Organization LkSingle Owner ❑ Partnership ❑ Corporation ❑ Other <br /> Estimated Number of Full Time Employees Estimated Number of Part Time or Seasonal Employees —1- <br /> Applicant Last Name n �A rj Applicant First Name: A 2 1 0 <br /> Applicant Mailing Address: j /��r�/✓ r✓Cn. 5• ZEN -/4C3 S Z��S <br /> 1, <br /> City State :" Applicant Phone No. Zlj/� L 7 <br /> Water Supply Public ❑ On-srte Well Sewage Disposal: Public El 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. <br /> Applicant's Signature. <br /> STAFF USE ONLY <br /> G/P Designation: �� -Z L Zonin v Use Type:X ' I�U-� \ 1 - UOV4 <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 A 1 / ( K yrV/e- 1- <br /> Remarks: ( 1 rc S j/ 1 tl 'r C <br /> Occ Grp. <br /> Accepted as Complete: Date: <br /> F:1DevSvc\Planning Applicalion FormskBusiness License(Revised 7-14-11) Page 2 of 8 <br />