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APPLICATION -- BUSINESS LICENSE --SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT APR 1.0 20"13 BUSINESS LICENSE NO. TO BE.CdM" L * X'THE APPLICANT PRIOR TO FIL"ING-THE APPLICATION'' '. Business Information Business Name: Uon% O,Lb FI,tC a j {-00 AALYi 04t Business Address: `a, Uvb hisA. Cross St DBA Mailing Address: I�5un M � ja City: State: ZIP: 1-5204/ Phone#: - ISS- Assessor Parcel Number(s): G Email: Other Businesses at this Address: Previous Business at Address: Description of Business Operation:: fiu Jyx- Type of Organization: Single O ner ❑ Partnership ❑ Corporation ❑ Other: Estimated Number of Full Time Empi gees: Estimated Number of Part Time or Seasonal Employees: Applicant Last Name: a— Applicant First Name: D Applicant Mailing Address: Kq7VALM CitySt to � j ZIP qq?4 Applicant Phone No: Water Supply: jkpublic ❑ On site Well Sewage Disposal: JX Public ❑ Septic System Will there be any sale of firearms? Yes 1 No NOTE: ANY CHANGE OF OCCUPA CY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. I, affirm,under penalty of perju y that all the above information is true and correct Date: f,the Owner/Agent agree,to de nd,indemnify, and hold harmless the County and its agents,officers and employees from any claim,action or proceeding against the County arising from the OwnerlAg is oject.Applicant's Signature: r Pa •-STAFF USE ONLY G/P Designation: C Zo ing: Use Type: b DEPARTMENT ROVED DENIED DATE Development Services Planner Name: Building Inspection Environmental Health Div ,��^ ,�/ _ S�p p / Fire Warden+ ( -- _ - Public Works I M.H.C.S.D. ---- License Approved For. ma Remarks: Occ.Grp. Accepted as Complete: Date: F/ApplicationsForms&Handouts/Planning pplications/Business License(Revised 11-1411) Page 2 of 6