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D <br /> APPLICAT ;" — BUSMESS EICE�N.SE <br /> J.•'�E'•.O i i 3.F =. t =.1. <br /> 2FEB 2 5 2004 SAN JOAQUIN COUNTY COMMU ITY DEVELPMNEPARTMENT <br /> Ld <br /> BUSINESS LICENSE NO. <br /> - � NViRUNMEIdT HEATH <br /> ��lFOR� <br /> TO BE COMPLETED BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> nsiness Information <br /> Business Name: <br /> Business Address: p Cross St j-Q_))6.h Ca wl <br /> Mailing Address: r r t f 110 1 City: 8 State:C,4 Zip:Cj 53 ,6 <br /> Phone M 6q I Assessor Parcel Number(s): <br /> Other Businesses at this Address: <br /> Previous Business at Address: <br /> Type of Business: <br /> Type of Organization: Single Owner ❑ Partnership ❑ Corporation © Other- <br /> Estimated <br /> therEstimated Number of Ful[Time Employees: Estimated Number of Part Time or Seasonal Employees: <br /> Applicant Last Name: 41,11AD Applicant First Name: <br /> Applicant Address: 9- <br /> City r/ State { ZIP 9536G Applicant.Phone No t' 3 <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 MREQUIRE B ILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> Applicant's Signature: Date: �.— /S ^ Q <br /> STAFF USE ONLY { <br /> GIP Designation: Zoning: r Ilse Type: G (� e 5e_005, f t <br /> DEPARTME APPR VED DENIED DTE <br /> Development Services Planner Name: <br /> Building Inspection <br /> Environmental Health Div <br /> Fire Warden <br /> Public Works <br /> Solid Waste <br /> Enforcement Officer <br /> License Approved For: V, 1 (,, 0- SCPJ 110 rl M <br /> �. 1. 17 I y►�e.ti � 2/'�if'i <br /> Remarks: �, 1. cif h ✓ �� w �p,� O� ►�rJ� L 1�� <br /> d eti <br /> Accepted as Complete: Date: <br /> F:0evSv6P1anning Application FonnslSusiness License(Revised 1231-02) Page 3 of 8 <br />