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FN <br /> APPLICATION - BUSINESS LICENSE <br /> r . APR 19 2016 SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> ENVIRONMENTAL HEALTH <br /> BUSINESS LICENSE NO. <br /> c; acs/ PERMITISERVICES <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: -k 6 FP-- <br /> Business Address: 2 8 115 f I t'f-C Cross St CLI' . <br /> DBA Mailing Address: 7 g 2, k.'��� �� City: f;, ',C State: <br /> Phone#: 2,AO` $3 j U 0 L {2 Assessor Parcel Number(s): J-0 D O , <br /> Email: <br /> Other Businesses at this Address: �- <br /> Previous Business at Address: `A <br /> Description of Business Operation:: 7— <br /> I <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: �Z Cq d Z ©v L Applicant First Name: pt d q1 <br /> Applicant Mailing Address: �I 2 F3 C # 57 T Y 4 C,� a S 3 6 <br /> City Tr- State cA ZIP IT1 ivy Applicant Phone No: 2ti7 g 33 06 ,21-11 <br /> Water Supply: ❑Public On-site Well Sewage Disposal: ❑ Public Septic 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,under penalty of perjury that all the above information is true and correct Date: <br /> I,the Owner/Agent agree,to defend,indemnify,and hold harmless the County and its Gt—ro G <br /> agents,officers and employees from any claim,action or proceeding against the County <br /> arising from the Owner/Agent's project. <br /> Applicant's Signature: <br /> STAFF USE ONLY <br /> G/P Designation: F Zoning: C 'Ca Use Type: <br /> DEPARTMENT APPROVED DENIED DATE <br /> Development Services Planner Name: rn , U .t <br /> Building Inspection C� <br /> Environmental Health Div ��jy✓` �j� �(7 v y-10 <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> License Approved For. t ve <br /> Remarks: G - 1�'t;7j-}1 —�?fD?l3 <br /> Occ.Grp. <br /> Accepted as Complete: Date: <br /> F/ApplicationsFonns&Handouts/PlanningApplicabons/Business License(Revised 02-2415) <br /> Page 2 of 6 <br />