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40 APPLICATION - BUSINESS LICENSE SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT//DEPARTMENT BUSINESS LICENSE NO. aRa V05 MAR -8 AN 9- 2 T91 :APPLICANT PRIt�a TO FILING THE APP'Li�A 'IOI l . ... :,�_ Business Name: (� �,p ��I)!'.�`I P_ �QY l C PeAi�'I ✓I - *y Business Address: i 0 �'�C�, '-�Q Q Cross St Mailing Address: 108,50 S i 4Q r la o City: V f P hGt (20 M n I State: 0°' I ZIP: QSa3� Phone#: Aoq _NO a.--C)11 ,45- Assessor Parcel Number(s): I Other Businesses at this Address: 0 r- wa,(� I Previous Business at Address: f Type of Business: -1 aoCk 41 re 5'e r'y 1 Ce. i Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other. { i Estimated Number of Full Time Employees: Estimated Number of Part Time or Seasonal Employees: O Applicant Last Name: l JC I r n t C K lApplicant First Name: t m e i Applicant Address: 1 q 0`1 LoA e lvG w Av vu, r City m5�o I State" I ZlPqC3,yl Applicant Phone No: a0 C{- s a - to a 0. J Water Supply:)2kublic ❑ On-site Well I Sewage Disposal: ❑ Public Septic System I �- Will there be any sale of firearms? ❑ Yes PNo I NOTE: ANY CHANGE OF JOCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. I,affirm,all the above i�formation is t e and correct Date: Applicant's Signat� C1.�� 1'3 i- d " "- vSTAFF USE ONLYrf- W— -�-vYub s� s�,,v+ -WA4k--s l G/P Designation: Zoning: -G Use Type: 6Nt'ei;- lndV'A r i ai 7 DEPARTMENT APPROVED DENIED �Q/� DATE Development Services Planner Name: 2 Building Inspection `�� 1 Z ` I "1 ,,,,,, ( / / l Environmental Health Div �� l �lYr( /�.�/t_Jl 3-F Fire Warden Public Works Solid Waste Enforcement Officer II License Approved For: c3em i --w6 v— . rte ',.'ef,"VS Remarks: _ _ 1.,/1 I _ -tYV vi - f�� I�(*' 7a-Y�!'1 M foe- I►'V� F 't _ t ,V I Accepted as Complete: I Date: F:\DevSvc\Planning Application Forms\Business License(Revised 07-16-04) Page 3 of 8