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APPLICATION --- BUSINESS LICENSE <br /> 11. 2414 <br /> APR SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> cC' /f• z :� <br /> BUSINESS LICENSE NO, �..-~1�I 1](,1�i <br /> �a�i pact` Ef�MR RMIT�SERVICES�4i <br /> Td BE.COMPLETED BY THE APPLICANT PRIQR TO FILING:TNE-APPLICAT[ON';'- <br /> Business Inform6flon s:. <br /> Business Name: <br /> Business Address: Cross St <br /> DBA Mailing Address:`7 City: aL State: ' ZIP: <br /> Phone#: Assessor Par f�Number(s): <br /> Email: <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Description of Business Operation:: _ �> > ew <br /> dr <br /> Type of Organization: Single Owner ❑ Partnership ❑ Corporation ❑ Other, <br /> Estimated Number of Full Time Employees: 2-- Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: Applicant First Name: <br /> Appllcant Mailing Address: O r f0 <br /> City &. State GMK} ZIPg52Q3 Applicant Phone No: 2e) 9—72— <br /> Water Supply: ❑Public ❑ On-site Well Sewage Disposal: ❑ Public ❑ Septic System <br /> Will there be any sale of firearms? n Yes ❑ No <br /> NOTE: ANY CHANGE OF OCCUPANCY MAY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I,affirm, under penalty of perjury that all the above information is true and correct Date: <br /> 1,the Owner/Agent agree,to defend,indemnify,and hold harmless the County and its /�� 0l <br /> agents,officers and employees from any claim,action or proceeding against the County I/ <br /> arising from the Ow � . ent' project. <br /> Applicant's Sign ur <br /> -.STAFF USE ONLY <br /> GIP Designation: Zoning: Use Type <br /> DEPARTMENT APPROVED DENIEDne <br /> DATE <br /> Development Services Planner Name: YN <br /> Q <br /> Building Inspection <br /> Environmental Health Div AU.� I ��� zt <br /> Fire Warden t'(Lu, <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For. <br /> Remarks:sf — dl <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicationsFor s&HandouWPlanningA pliccation"s/Business U rise Revised 1 t-14-11) I^ -� <br /> Page 2 of 6ttUr�t� �UAS � f�v r�a,lC rel tS Jus� r ✓ ,,�I��`�,"�, & <br />