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APPLICATION - BUSINESS LICENSE <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> BUSINESS LICENSE NO. <br /> \�\p' .\P <br /> <Ip R� <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: ex 71 S 9-Y vi C-0- <br /> Business Address: f Cross St ✓42t <br /> DBA Mailing Address: ' (� . City: State: ZIP: '1S` p <br /> Phone#: CZ C) 64, 0,& Assessor Parcel Number(s): /.?5D qO - Q <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Type of Business. <br /> Type of Organization: 'Single Owner ❑ Partnership ❑ Corporation ❑ Other: <br /> Estimated Number of Full Time Employees: V\.C-2 . Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: B L\SS Applicant First Name: Is <br /> Applicant Mailing Address: 7 G`7-9 u�•+ CJJ <br /> City `TY�;�. Stat�„� ZIP 9Sj Applicant Phone No: 7 o 3 66 - -/k 7 k <br /> Water Supply []Public KOn-site Well Sewage Disposal: ❑ Public 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,all the above information is true and correct Date: <br /> Applicant's Signature: -4 q a iso <br /> STAFF USE ONLY <br /> G/P Designation: Zoning: — Use Type: /\e cu-" L�/- <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Nam : �1 1,2(10 <br /> Building Inspection <br /> Environmental Health Div J <br /> Fire Warden <br /> Public Works <br /> Sheriff(Junk Dealers Only) <br /> License Approved For: <br /> ENVIRONMENTAL HEAD Iri <br /> Remarks: <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F.\DevSvc\Planning Application Forms\Business License(Revised 09-01-09) Page 2 of 7 <br />