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APPLICATION — BUSINESS LICENSE <br /> y� SAN .IOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> X <br /> BUSINESS LICENSE NO. <br /> rfFsR�':� 2005 DEC -7 PM : 5 <br /> TO BE COMPLETED j , , -'o ` 14T PRIOR TO FILING-THE:APPLICATION <br /> euviAMN Tn 0m,cl-tioln <br /> Business Name: 02 fAd <br /> Business Address: & Cross St <br /> DBA Mailing Address: City: State: ZIP: <br /> Phone#: 2 Assessor Parcel Number(s): — C <br /> Other Businessg at this Address: <br /> Previous Business at Address: <br /> Type of Business: 0 <br /> Type of Organization: Single Owner ❑ Partnership ❑ Corporation ❑ Other. <br /> Estimated Number of Full Time Employees: T Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: Applicant First Name: <br /> Applica Mailing dress: t41yd 2- ,CQA-- <br /> City 1 SStat ZI Applicant Ph ne No: ? <br /> Water Supply: ❑Public Ob--On-site Well Sewage Disposal: ❑ Public ptic System <br /> Will there be any sale of firearms? ❑ Yes p1<0 <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I,affirm,all the above informationis tr a and co rr Date: <br /> Applicant's Signature: <br /> 1 <br /> STAFF ONLY <br /> G/P Designation: L Zoning: FUse Type: l <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name- -'L v <br /> O� <br /> Building Inspection <br /> Environmental Health Div —�S <br /> Fire Warden <br /> Public Works <br /> Solid Waste <br /> Enforcement Officer <br /> M.H.C.S.D. <br /> License Approved For: t/`L p hl / <br /> Remarks: 4 <br /> �u <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F:\DevSvc\Planning Application Forms\Business License(Revised 10-20-05) Page 3 of 8 <br />