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APPLICATION - BUSINESS LICENSE <br /> �.•art .o <br /> SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br /> `� .• BUSINESS LICENSE NO._L A . <br /> TO BE COMPLETE6 BY THE APPLICANT PRIOR TO FILING THE APPLICATION <br /> Business Information <br /> Business Name: (?k,'I CA2.r\ r C —-r I <br /> Business ddre s: -4— �(,� Cross St I'Y1C( <br /> DBA Maili g dress: IW LD. l I City: ( State: ZIP. 537 <br /> Phone#: _ ! �p�-� Assessor Parcel mber(s) 1(j <br /> Email: IA( O-v- f lel <br /> Other Businesses at this Address: <br /> Previous Business at Address: Y {{ <br /> Description of Business Operation:: GW;e� �, I 1 <br /> ✓l A-fLkCSC <br /> f <br /> .i <br /> Type of Organization: ❑ Single Owner ❑ Partnership Corporation ❑ Other: r <br /> Estimated Number of Full Time Employees: I Estimated Number of Part Time or Seasonal Et lines <br /> Applicant Last Name Applicant First Name: Td n I <br /> Applicant Mailing Address: <br /> City t State ZIP Applicant Phone No: <br /> Water Supply: ❑Public On-site ell Sewage Disposal: ❑ Public Nr Septic System <br /> Will there be any sale of firearms ❑ Ye No <br /> NOTE: ANY CHANGE OF OCCUPANCY 16 AY REQUIRE BUILDING IMPROVEMENTS AND NECESSARY BUILDING PERMITS. <br /> I,affirm, under penalty of perjury tha all the above information is true and correct Date: <br /> I,the Owner/Agent agree,to defend, ndemnify, and hold harmless the County and its <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. L L Zoning: - Use Type:j <br /> DEPARTMENT APPRO ED DENIED DATE <br /> Development Services Planner Name: <br /> Budding Inspection <br /> Environmental Health Div l <br /> Fire Warden <br /> Public Works <br /> M.H.C.S.D. <br /> A,4 aiic <br /> License Approved For. ( (to LAA \ 1 / <br /> Remarks: <br /> Occ. Grp. <br /> Accepted as Complete: Date: <br /> =\DevSvc\Planrnng Application Forms\Business License(Revised 01-25-10) Page 2 of 7 <br />