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APPLICATION — BUSINESS LICENSE <br /> - '• \� SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> d �+ <br /> BUSINESS LICENSE NO. L <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: <br /> Business Address SJ WOC490 9p Gq Cross St Rvkt C <br /> DBA MailingAddress:1gD W City: STOC yo N) State: �� ZIP: �S�� <br /> Phone#: c) 3 — S 7 p Assessor Parcel Number(s): <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: iRe S S Cl N U ' C Q <br /> Type of Organization: R) Single Owner ❑ Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: K h c• Applicant First Name: L�R <br /> Applicant Mailing Address: S?�7 WA-tell(Ic) S D C Te N <br /> City C` vC CN State CA ZIP � Applicant Phone No cq <br /> Water Supply. 14Public ❑ On-site Well Sewage Disposal: ❑ Public ❑ Septic System <br /> Will there be any sale of firearms? ❑ Yes Eli 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: q •- S— <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: rt k <br /> STAFF USE ONLY <br /> GIP Designation C Zoning U-6) Use Type:�UUU Y V—U <br /> DEPARTMENT APPROVED DENIED DAT <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: itffi ` <br /> Remarks: ` t) .U 3 <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 />