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APPLICATION - BUSINESS LICENSE <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />2005 APR 12 PM 12:50 BUSINESS LICENSE NO.1;4—_ _ �� 4 O) -'O) <br />TO BE COMPLETEDI$X PRiPWNT PRIOR TO FILING THE APPLICATION <br />Busi <br />ss Information <br />Business Name: W <br />(; /P 6;,VT <br />Business Address: 6U R <br />Cross St , <br />DBA Mailing Address: #,�-> /-A V-' <br />City: -RAC YState: <br />Phone <br />Assessor Parcel Number(s):2 0 - ) �-� �'� I t✓l <br />Other Businesses at this Address: IMAM 40 uplum <br />Previous Business at Address: 16 10A:L <br />Type of Business: Q 7 z <br />C rtol <br />Type of Organization: Y,Single Owner ❑ Partnership <br />❑ Corporation ❑ Other: <br />Estimated Number of Full Time Employees: <br />Estimated Number of Part Time or Seasonal Employees: <br />Applicant Last Name: <br />Applicant First Name: <br />Applicant Mailing Address: QNc, e''T <br />Sr <br />City tLI&Z Stat ZIP <br />I Applicant Phone No: S "aSGS <br />Water Supply: ❑Public On-site Well <br />Sewage Disposal: ❑ Public 7SSeptic 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 theove information is true and correct <br />Applicant's Signatu <br />Date: <br />rOs <br />STAFF USE ONLY <br />G/P Designation-' (, Zoning .lis' L, <br />Use Type: V` )") Lko <br />DEPARTMENT APPROVE - DENIED <br />DATE <br />Development Services <br />Planner Name: 2 L� cr7 <br />Building Inspection <br />Environmental Health Div <br />Fire Warden <br />Public Works <br />Solid Waste <br />Enforcement Officer <br />M.H.C.S.D. <br />License Approved For:: <br />Remarks: DL 1 J. �i7 % L <br />lGQ %.0 40 C T lY`t LLL <br />Occ. Grp. <br />Accepted as Complete: <br />Date: <br />F \DevSvc\Planning Application Forms\Business License (Revised 07-28-04) Page 3 of 8 <br />