Laserfiche WebLink
APPLICATION - BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ::Iwo MAR 31 2016 <br /> BUSINESS LICENSE NO.—, �!�Qb� <br /> HEALTH <br /> PERK FMIERVIC0 <br /> L TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION - <br /> Business Information _ <br /> Business Name: S z p u c_i L V F_ C Y C-L-eS _ <br /> Business Address: -1013 of 1.1'QST. Cross St C-f 4 z (Z,-AD _--- <br /> DBA Mailing Address:I.C?3� ).I � S'r. City: ILA c-1 State: (�( ZIP: 9J 3 o y <br /> - <br /> PhoneAssessorParcelNumbe s: Lc _--- -- -_- <br /> aY: 2or7- `t33L-3�/`/ � ) <br /> Email s£�uo jtV£CVGi.rcS © yAtLvo , Cdr-1 -- -----------_ <br /> Other Businesses at this Address: ( - _ -- <br /> Previous Business at Address: r1 o-1-0 rt_Gq CLF_ SS p - - - <br /> Description of Business Operation:: sLtwi ci <br /> i� <br /> r <br /> t T•y;z of Organization: X Single Owner [_] Partnership C3 Corporation ❑ Other. <br /> Esilinated Number of Full Time Employees: -4-• Estimated Number of Part Time or Seasonal Employees: <br /> ri Applicant last Name: C¢>.V1kL\A0 Applicant First Name: <br /> A_nlicant Mailing Address: p.0.(3 ra x 4,2-%-7 <br /> II^------.-----• -----••-- <br /> I, Ciy per F G� State C ZIP-jS3-3(ol Applicant Phone No: 20 5-(, A 0-oyy <br /> (I 4Jcter^,u;ply: ❑Public L On-site Well Sewage Disposal: ❑ Public Septic System 1 <br /> I! ON;them be arty sale of firearms? F-1YesNo <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. _ 11 <br /> I,affirm,under penalty of perjury that all the above information is true and correct Date: j• <br /> 1! 1: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/Ag s project. �. <br /> Applicant's Signutum: <br /> STAFF USE ONLY <br /> GIP Designabutt: G Zoning: Use Type: <br /> DEPARTMENT APF' OVED DENIED <br /> Development Services -- Planner Name: <br /> Building Inspection --- --1 <br /> r Environmental Health Div — ----- --- tx'V-1 51A, lug, �$ ''/ I <br /> Fire Warden 19AO-1 -- ---- -- ---- -- -_------- <br /> Public Works <br /> M_H_C.S_D. - -- - ------ ----- -�i <br /> License Approved For. lywww re pur <br /> -------- 1, <br /> Remarks+�� 4`--�/� � ---,L-t- - - ----- _-. <br /> Occ.Grp. {{ <br /> Accepted as Complete: -- •-------._ - -- Date: - --.-----'-'1I <br /> F/AppiicationsForms&Handouts/PlanningApplications/Business License(Revised 02-24-15) <br /> Page 2 of 6 <br />