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WHEN REVIEWED AND APPROft PLEASE
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<br /> u S N JO •OUIN Ct OTY C MMUNITY
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<br /> w J ?iin^J3 810 EAST NAZELTON AVENUE LICENSE
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<br /> CA 95205 r DEPARTMENT
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<br /> B.L NO. c--(, 3 —, 3
<br /> RECEIPT NO. ' U ca (o
<br /> FEE: U °!-
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<br /> Business Name: u o—Q., L NiaS DBA(H different):�,
<br /> Business Address: Cog f BLU D ,l 5-t—b G'--L"-j ey SZ
<br /> Other Businesses at Address:
<br /> Phone:�20 �p ,� Assessor Parcel Number(s): Z —
<br /> Mailing Address:
<br /> Type of Business: :1) C,
<br /> Type of Organization: Single Owner ❑ Partnership ❑ Corporation ❑ Other:
<br /> Estimated Number of Full me Employees: 5— Estimated Number of Part Time or Seasonal Employees: Z
<br /> Owner(s) Name: �J t 7" j L H4 r.)DCC,
<br /> Owner(s)Address: — D due_-D
<br /> Manager's Name:
<br /> Previous Business at Address: 2n4
<br /> Other Local Business Loca Iona (Address):
<br /> Water Supply: Wublic ❑ On-eke Well Sewage Disposal: Public ❑ Septic System
<br /> Will there be any retail eels of pistols,revolvers or other concealable firearms? ❑ Yea XNo
<br /> NOTE: ANY CHANGE OF OCCUPANCY WILL REQUIRE BUILDING INPROVEMENTS AND NECESSARY BUILDING PERMITS.
<br /> Applicant's Signature: Date: 3
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<br /> General Plan Designation: C Zoning: CAI V Code Section Number:
<br /> DEPARTMENT APPROVED DENIED BY DATE
<br /> Development Services I1-1—q3
<br /> —
<br /> Building Inspection
<br /> Environmental Health Diva
<br /> 1
<br /> Air Pollution Control Dist
<br /> Sheriff(firearm sales only)
<br /> Fire District
<br /> License Approved For: pr te Ar
<br /> Remarks: uLe..5 I-L ,S.G v 4/tth
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<br /> Accepted ae Completes
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<br /> Copies:WHiTE-Developme GREEN-Building,CANARY-Fire District,PINK-Environmental Health,GOLDENROD-APCD
<br /> : ^ PA_BLLG Rev.June 18,1993
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